Electrosurgical System

ABSTRACT

A system and method involving an electrode system can include a flexible shaft.

TECHNICAL FIELD

This invention relates generally to epidural field therapy.

BACKGROUND

The use of radiofrequency (RF) generators and electrodes to be appliedto tissue for pain relief or functional modification is well known. Forexample, the RFG-3B RF lesion generator of Radionics, Inc., Burlington,Mass. and its associated electrodes enable electrode placement of theelectrode near target tissue and heating of the target tissue by RFpower dissipation of the RF signal output in the target tissue. Forexample, the G4 generator of Cosman Medical, Inc., Burlington, Mass. andits associated electrodes such as the Cosman CSK, and cannula such asthe Cosman CC and RFK cannula, enable electrode placement of theelectrode near target tissue and heating of the target tissue by RFpower dissipation of the RF signal output in the target tissue.Temperature monitoring of the target tissue by a temperature sensor inthe electrode can control the process. Heat lesions with target tissuetemperatures of 60 to 95 degrees Celsius are common. Tissue dies byheating above about 45 degrees Celsius, so this process produces the RFheat lesion. RF generator output is also applied using a pulsed RFmethod, whereby RF output is applied to tissue intermittently such thattissue is exposed to high electrical fields and average tissuetemperature are lower, for example 42 degrees Celsius or less.

RF generators and electrodes are used to treat pain and other diseases.Examples are the equipment and applications of Cosman Medical, Inc.,Burlington, Mass. such as the G4 radiofrequency generator, the CSKelectrode, CC cannula, and DGP-PM ground pad. Related information isgiven in the paper by Cosman E R and Cosman B J, “Methods of MakingNervous System Lesions”, in Wilkins R H, Rengachary S (eds.);Neurosurgery, New York, McGraw Hill, Vol. 3, 2490-2498; and is herebyincorporated by reference in its entirety. Related information is givenin the book chapter by Cosman E R Sr and Cosman E R Jr. entitled“Radiofrequency Lesions.”, in Andres M. Lozano, Philip L. Gildenberg,and Ronald R. Tasker, eds., Textbook of Stereotactic and FunctionalNeurosurgery (2nd Edition), 2009, and is hereby incorporated byreference in its entirety.

The Cosman CC cannula and RFK cannula, manufactured by Cosman Medical,Inc. in Burlington, Mass., include each an insulated cannula having apointed metal shaft that is insulated except for an uninsulatedelectrode tip. The cannula has a hub at its proximal end having a luerfitting to accommodate a separate thermocouple (TC) electrode, forexample the Cosman CSK electrode, Cosman TCD electrode, and Cosman TCNelectrode, that can deliver electrical signal output such as RF voltageor stimulation to the uninsulated electrode tip. The Cosman CSK and TCDelectrodes have a shaft that is stainless steel. The Cosman TCNelectrode has a shaft that is Nitinol. A disadvantage of this system isthat fluid injection into the cannula cannot be achieved when the TCelectrode is also in the cannula. Another disadvantage is that thetemperature sensor probe and the cannula are separate elements, whichincreases the complexity of the components needed for the system.Another disadvantage of the Cosman CC and RFK cannula is that its shaftis constructed from stainless steel hypotube. Another disadvantage ofthe Cosman CC and RFK cannula is its shaft is not flexible enough forepidural placement. Related information is given in Cosman Medicalbrochure “Four Electrode RF Generator”, brochure number 11682 rev A,copyright 2010, Cosman Medical, Inc., and is hereby incorporated byreference herein in its entirety.

Each injection electrode made by Cosman Medical Inc. (Burlington,Mass.), including the CU electrode, the CR electrode, and the CPelectrode models, has a shaft including metal tubing with sharp distalend for insertion into tissue to reach a spinal target. The shafts ofthe Cosman injection electrodes have lengths 6 cm (2.4 inches), 10 cm(3.9 inches), or 15 cm (5.9 inches). The shaft of a Cosman injectionelectrode is configured to penetrate the skin surface, muscle, and othertough bodily tissues to enable percutaneous placement of the electrodetip at nerves outside and around the bony spinal column. The shaft of aCosman injection electrode is insulated except for an exposed conductivetip portion and has an electrical connection to a signal generator fordelivery of stimulation or RF signal outputs to the target tissue. Eachhas a flexible injection tube and a port to allow injection of contrast,anaesthetic, or saline solution fluid to the target tissue. The CUelectrode incorporates a temperature sensor positioned within theexposed, conductive tip portion. The CR and CP electrodes do notincorporate a temperature sensor. The CP electrode can be used to effecta stimulation-guided nerve block, whereby an electrical stimulationsignal is applied to the CP electrode via its electrical connector,stimulation signals are applied to nerve tissue nearby the conductivetip of the CP electrode, and anesthetic fluid is injected through the CPshaft once desired stimulation response is achieved by positioning ofthe exposed tip. The CR electrode can be used to effect astimulation-guided RF therapy without temperature control, whereby anelectrical stimulation signal is applied to the CR electrode via itselectrical connector, the stimulation signal is applied to nerve tissuenearby the conductive tip of the CR electrode in order to position theexposed tip of the electrode near target nerves, RF generator output isapplied to the CR electrode via the same electrical connector, RF outputis applied to tissue nearby the exposed tip of the electrode withouttemperature monitoring. The CR electrode can also be used to effectnon-stimulation-guided RF therapy, whereby stimulation guidance is notutilized. The CU electrode can be used to effect a stimulation-guided RFtherapy with temperature monitoring and control, whereby an electricalstimulation signal is applied to tissue via the CU electrode to positionits exposed tip near target nerves, and RF output is applied to tissuenear the exposed tip to effect medical treatment. The CU electrode canalso be used to effect non-stimulation-guided RF therapy, wherebystimulation guidance is not utilized. The Cosman injection electrodesare not configured to be positioned by the epidural space. The shafts ofthe Cosman injection electrodes are not substantially flexible. Thelengths of the Cosman injection electrodes' shafts are less than 5.9inches. The Cosman injection electrodes are not structed using a springcoil. The Cosman injection electrodes are not introduced into the humanbody via an introducer needle, such as an epidural needle. Relatedinformation is given in Cosman Medical brochure “Four Electrode RFGenerator”, brochure number 11682 rev A, copyright 2010, Cosman Medical,Inc., and is hereby incorporated by reference herein in its entirety.

In one embodiment, U.S. Pat. No. 7,862,563 by E R Cosman Sr and E RCosman Jr presents a unitized injection electrode with anelectrically-insulated shaft, an exposed metallic tip, a temperaturesensor within the exposed metallic tip, cables that connect to theelectrode via a single, flexible leader connector that splits into twoparts of which the first is terminated by a connector configured tocarry high-frequency and stimulation signals and temperature-measurementsignals, and the second is terminated by an injection port through whichfluid can be injected into the shaft and out the distal end of theelectrode. One limitation of this prior art is that it does not show aunitized injection electrode for which the metallic tip and insulatedshaft are constructed using a spring coil and a central stiffening wire.One limitation of this prior art is that it does not show theapplication of a unitized injection electrode in the epidural space.

In the prior art, the Cosman TEW electrode system includes an electrodewith a spring-coil tip that has a temperature sensor at its distalclosed end. The TEW electrode is introduced into the human body by meansof an insulated cannula. The TEW electrode is designed for RF treatmentof the trigeminal facial nerve via the foremen ovale of the human skull.The TEW electrode is not electrically insulated. The shaft of the TEWelectrode is a metallic tube to the distance end of which is attached aspring coil. The coil tip of the TEW electrode is configured to emergefrom the end of the cannula and into the body without divergingsubstantially from its predetermined curve. The TEW electrode's springcoil is no longer than 0.33 inches. The TEW electrode's spring coilemerges from the distal end of the cannula by no more than 0.33 inches.The TEW electrode is not configured to be threaded though the epiduralspace. The TEW electrode is not configured to be threaded through 12inches to 34 inches of the epidural space. The TEW electrode is not longenough to apply RF therapy to multiple spinal nerves via a single skinpuncture and the epidural space. The TEW electrode does not have aninjection port. The TEW electrode is not configured to allow for outflowof fluids from its spring coil tip. Related information is given inCosman Medical brochure “Four Electrode RF Generator”, brochure number11682 rev A, copyright 2010, Cosman Medical, Inc., and is herebyincorporated by reference herein in its entirety.

The Cosman Flextrode RF electrode system includes an electrode and anintroducer cannula. The flextrode electrode's shaft is approximately 15cm (5.9 inches) in length and is constructed from a metal tube whosedistal end has a spiral cut over the distal 1.25 inches. A temperaturesensor is located at the distal, closed end of the shaft. The electrodeis induced into the human body via the introducer cannula which has asharped distal end and whose shaft is electrically insulated. When theelectrode is introduced through the cannula, 11 mm of the electrodeextends beyond the cannulas distal end into the tissue. The Flextrodeelectrode is not electrically insulated. RF energy is applied to thetissue by the length of the Flextrode electrode that extends beyond thecannula's distal tip and the uninsulated distal tip of the cannula. TheFlextrode is configured to penetrate tissue, such as the fibrous tissueof the intervertebral disc, where it emerges from the distal end of thecannula. The Flextrode's stiffness is configured so that its tip canmove through the curved tip of the introducer cannula but remainsubstantially straight as it penetrates tissue. The Flextrode electrodeis not configured for placement in the epidural space. The Flextrode isnot configured for injection of fluids into the human body. Relatedinformation is given in Cosman Medical brochure “Four Electrode RFGenerator”, brochure number 11682 rev A, copyright 2010, Cosman Medical,Inc., and is hereby incorporated by reference herein in its entirety.

The Radionics DiscTrode RF electrode system includes an electrode and anintroducer cannula. The disctrode electrode's shaft is approximately 9inches in length and is constructed from a metal tube whose distal endhas thin cuts over the distal 2.5 inches. A temperature sensor islocated at the distal, closed end of the shaft. The electrode is inducedinto the human body via the introducer cannula which has a sharpeddistal end and whose shaft is electrically insulated. When the electrodeis introduced through the cannula, 5 cm (2 inches) of the electrodeextends beyond the cannula's distal end into the tissue. The disctrodeelectrode is not electrically insulated. RF energy is applied to thetissue by the length of the disctrode electrode that extends beyond thecannula's distal tip and the uninsulated distal tip of the cannula Thedisctrode is configured to penetrate tissue, such as the fibrous tissueof the intervertebral disc, where it emerges from the distal end of thecannula. The disctrode's stiffness is configured so that its tip canmove through the curved tip of the introducer cannula but remainsubstantially straight as it penetrates tissue. The disctrode electrodeis not configured for placement in the epidural space. The disctrode isnot configured for injection of fluids into the human body. Relatedinformation is given in an article by P M Finch entitled “The Use ofRadiofrequency Heat Lesions in the Treatment of Lumbar Discogenic Pain”,Pain Practice, Volume 2, Number 3, 2002, pages 235-240, which is hereincorporated by reference herein in its entirety.

The Oratec Spinecath system includes a catheter and an introducercannula. The catheter's shaft consists of a resistive coil that isentirely covered by electrical insulation. RF energy applied to the coilheats the internal resistive coil and tissue is heated by thermalconduction. RF energy is not applied to the tissue. A temperature sensoris located in the spinecath catheter. The electrode is induced into thehuman body via the introducer cannula which has a sharped distal end.The spinecath emerges from the distal end of the cannula byapproximately 5 cm (2 inches). The spinecath catheter is not configuredfor placement in the epidural space. The spinecath is not configured forinjection of fluids into the human body. Related information is given inan article by P M Finch entitled “The Use of Radiofrequency Heat Lesionsin the Treatment of Lumbar Discogenic Pain”, Pain Practice, Volume 2,Number 3, 2002, pages 235-240, which is here incorporated by referenceherein in its entirety.

The use of catheters in the epidural space to treat pain is well known.A flexible catheter is introduced into the epidural space through anepidural needle inserted percutaneously through the sacral hiatus,through an intervertebral foramina, or through vertebral interspaces. Aninjection adaptor, such as a tuohy-borst adaptor, can be attached to theproximal end of the catheter to provide for the injection of fluids intothe proximal end of the catheter that outflow into patient anatomythrough the distal end of the catheter. Techniques such as lysis ofadhesions, chemical neurolysis of nerve roots, and other medial methodsare well known. Examples of epidural catheters include the Tun-L-XLcatheter manufactured by EpiMed International, Farmers Branch, Tex. TheTun-L-XL catheter comprises a stainless steel spring coil whose distalend is welded into a ball, and which is covered by a plastic tube overits entire length except for the distal end. The coil wire is closelycoiled except for a region of the exposed, distal coil where the coolloops are loosely wound to provide for preferential outflow of injectedfluids. The coil can have a metal safety strap welded at the proximaland distal end of the coil. A stylet comprising a metal wire and aplastic hub attached to the proximal end of the wire, is inserted intothe proximal end of the catheter to stiffen it. The stylet is removed,an injection adaptor is attached to the proximal end of the catheter,and fluids can be injected. Nerve stimulation signals can be deliveredthrough the exposed metallic tip of the catheter by connecting theproximal end of the stylet to the output of a nerve stimulator, perhapsby means of an alligator clip, while the stylet is positioned inside thecatheter. Related information is in “Epidural Lysis of Adhesions andPercutaneous Neuroplasty” by Gabor B. Racz, Miles R. Day, James E.Heavner, Jeffrey P. Smith, Jared Scott, Carl E. Noe, Laslo Nagy and HanaIlner (2012), in the book “Pain Management—Current Issues and Opinions”,Dr. Gabor Racz (Ed.), ISBN: 978-953-307-813-7, InTech, and is herebyincorporated by reference in its entirety. One disadvantage of the priorart in epidural catheters is that an electrode with a temperaturemonitoring is not used as a stylet. One disadvantage of the prior art inepidural catheters is that the stylet does not have an integratedconnection cable to an electrical generator. One limitation of the priorart in epidural catheters is that electrical stimulation cannot beapplied at the same time that fluid is injected through the catheter.One limitation of the prior art in epidural catheters is that priorcatheters do not provided for temperature-controlled RF lesioning. Onelimitation of the prior art in epidural catheters is prior cathetersystems have multiple pieces. One limitation of the prior art inepidural catheters is prior catheter systems are not a unitizedinjection electrode.

U.S. Pat. No. 6,246,912 by M E Sluijter, W J Rittman, and E R Cosmanpresents in FIG. 9 a catheter electrode with one or more electricalcontacts, where the catheter electrode is placed in the epidural spaceand applies high frequency signals via its electrical contacts. Theelectrical contact are tubular rings bonded to the substrate catheterand connected to wires internal to the catheter. The catheter may havereinforced metal spirals in its construction. The catheter electrodedoes not provide for the injection of fluids. The catheter electrodedoes not apply high frequency signals to the tissue by the same springcoil that is part of its shaft construction.

U.S. Pat. No. 8,075,556 by A Betts presents a specific construction of adevice configured for placement in the spinal canal and delivery of RFenergy. Betts describes a catheter delivery device to transmitradiofrequency energy to a spinal canal, comprising: a needle having anopen proximal end and an open distal end, and a lumen that extends fromthe open proximal end to the open distal end; a catheter having a blunt,metallic tip on a distal end of the catheter that transmits a radiofrequency energy to the treatment site, wherein the catheter istelescopically disposed within the needle lumen to allow the tip to bemaneuverably positioned within the spinal canal; a catheter hub coupledto a proximal end of the catheter a metallic wire element telescopicallydisposed within a lumen of the catheter; and an adapter hub coupled to aproximal end of the wire element, wherein the adapter hub iscooperatively engageable to the catheter hub to form a single shaft,wherein a proximal end of the adapter hub is configured couple to aradio frequency generating device, and wherein the adapter hub and thecatheter hub are sized and dimensioned relative to one another such thatengagement of the adapter hub to the catheter hub allows a distal end ofthe wire element to touch a seating surface of the tip such that thewire element delivers a radio frequency energy from the radio frequencygenerating device to the tip. A disadvantage of the prior art in Bettsis that the catheter has an adaptor hub. A disadvantage of the systemdescribed in Betts is that a standard epidural catheter is not used. Adisadvantage of the system described in Betts is that construction ofthe catheter using a metal coil is not described. A disadvantage of thesystem described in Betts is that a safety strap within the cathetershaft is not described; a disadvantage of the absence of a metallicsafety strap is that the impedance of the catheter shaft can distortand/or diminish electrical signals conducted along the shaft. Adisadvantage of the system described in Betts is that RF is notdelivered without seating of the RF wire in the inner surface of thedistal end of the catheter. A disadvantage of the system described inBetts is that the system does not provide for temperature monitoring. Adisadvantage of the system described in Betts is that the system doesnot provide for temperature-monitored RF therapy delivered through thecatheter. A disadvantage of the system described in Betts is that the RFwire does include a temperature sensor. A disadvantage of the systemdescribed in Betts is that it is not a unitized injection electrode. Adisadvantage of the system described in Betts is that the RF wire isseparate from the catheter. A disadvantage of the system described inBetts is that injection through the catheter cannot be effected whilethe RF wire is in place within the catheter. A disadvantage of thesystem described in Betts is that it does not provide for simultaneousinjection of fluids and delivery of electrical signals.

US patent application 2004/0210290 by Omar-Pasha describes a catheterelectrode for pulsed RF treatment of nerves in the epidural space. Onelimitation of this prior art is that does not describe the use of a coilto construct the catheter electrode. Another limitation of this priorart is it does not describe an RF electrode system in which an RFelectrode stylet is inserted into a standard epidural catheter.

The pulsetrode electrode manufactured by BioAmpere Research SRL, Verona,Italy is a flexible electrode comprising a plastic shaft, three ringelectrodes near its distal end, a hub, an injection port connected to atube that is connected directly to the hub, a generator wire thatconnects directly to the hub, a moveable stylet is inserted into theinjection port and travels along the shaft of the electrode. Thepulsetrode is configured for placement in the epidural space anddelivery of radiofrequency fields to anatomy. Related information isgiven in Bioampere Research brochure “Pulserode” and is herebyincorporated by reference herein in its entirety. One limitation of thisprior art is that does not describe the use of a coil to construct thecatheter electrode. Another limitation of this prior art is it does notdescribe an RF electrode system in which an RF electrode stylet isinserted into a standard epidural catheter. Another limitation of thisprior art is that the distal end of the electrode is electricallyinsulated. Another limitation of the this prior art is that the activetip is not the sole active tip.

SUMMARY

The present invention relates to a system and method involving anelectrode system having a flexible shaft. In one aspect, the presentinvention relates to a system involving a radiofrequency electrodeconfigured for placement within the epidural space. In one aspect, thepresent invention relates to a flexible electrode that provides forstimulation-guidance and the injection of fluids into the epiduralspace. In one aspect, the present invention relates to a system forperforming epidural pulsed RF using stimulation guidance and guidance bymeans of injection of radiocontrast agents from the active tip of theelectrode. In one aspect, the present invention relates to a method forconstruction of an epidural electrode system. In one aspect, the presentinvention relates to the construction of an epidural electrode usingmetal coil over the proximal end of which insulation is positioned. Inone aspect, the present invention relates to a one-piece electrodesystem with flexible shaft, and injection port, and a generatorconnector.

In one example, the epidural electrode system consists of a one-piece(also known as “unitized”) electrode with an injection port andgenerator connection, that is introduced percutaneously through anepidural needle. The electrode conducts electrical signals, such as RFand pulsed RF signals to tissue in contact with the electrode's activetip, when the electrode is energized by an electrical power supply, suchas a radiofrequency generator. In a more specific example, the electrodeincludes a temperature sensor within is active tip to providetemperature monitoring during the delivery of electrical signal, forexample to provide for temperature-controlled RF pain treatment.

In one example, the one-piece electrode's shaft is constructed using aspring coil whose proximal end is covered by an electrically-insulatedsheath, and whose distal end is closed by a weld that incorporates thespring coil, any internal RF wires, any internal thermocouple wires, andinternal structuring wires, such as a safety strap or fixed stylet. Oneadvantage of this example is ease of manufacturing.

In one example, the one-piece electrode's shaft is constructed using aspring coil whose proximal end is covered by an electrically-insulatedsheath; whose distal end is closed by a weld that incorporates thespring coil, any internal RF wires, any internal thermocouple wires, andinternal structuring wires, such as a safety strap; and into whoseproximal end a separate moveable stylet is inserted. One advantage ofthis example is ease of manufacturing.

In one example, the epidural electrode system consists of a two-piecesystem including a catheter with metallic tip and a RF electrodeconfigured to be placed within the inner lumen of the catheter. Oneadvantage of this example, this that the RF electrode can both deliverRF to the catheter tip, monitor the temperature at the catheter tip, andprovide variable stiffening of the catheter shaft and tip.

One advantage of using a coil to construct the shaft and tip of aunitized injection electrode is that the shaft is flexible. Oneadvantage of flexible shaft and tip in unitized injection electrode isthat the electrode can be placed in the epidural space of the humanbody. One advantage of an epidural unitized injection electrode systemis that injection of fluids and delivery of electrical signals, such asRF, can be effected at the same time. Ease of manufacturing is oneadvantage of the method of constructing a unitized injection electrodesystem for epidural RF using a spring coil covered with an insulativesheath and terminated at this distal end by a weld joint that capturesinternal RF and thermocouple wires.

Ease of manufacturing is one advantage of an epidural catheter electrodesystem for which an RF electrode is used as a stylet for an epiduralcatheter.

DESCRIPTION OF DRAWINGS

FIG. 1A is a schematic diagram showing a system including a catheterelectrode wherein the electrode is placed in the epidural space andenergized in a monopolar manner where a ground pad carries returncurrents from the electrode.

FIG. 1B is a schematic diagram showing a system including two catheterelectrodes wherein the electrodes are placed in the epidural space andenergized in a bipolar manner where current passes between electrodes.

FIG. 2A is a schematic diagram showing in an external view a unitizedinjection electrode with a flexible active tip, a flexible shaft, aninjection port, and a generator connector.

FIG. 2B is a schematic diagram showing in an external view a unitizedinjection electrode with a flexible active tip, a flexible shaftdepicted in a straight position, an injection port, and a generatorconnector.

FIG. 2C is a schematic diagram showing in a sectional view a unitizedinjection electrode where a coil is used in the construction of theshaft and active tip, and where the electrode has a an integratedstylet, temperature sensor, injection port, and a generator connector.

FIG. 2D is a schematic diagram showing in a sectional view a unitizedinjection electrode where a coil is used in the construction of theshaft and active tip, and where the electrode has a an integratedstylet, temperature sensor, injection port, and a generator connector.

FIG. 2E is a schematic diagram showing in a sectional view a unitizedinjection electrode where a coil is used in the construction of theshaft and active tip, and where the electrode has a an integrated safetystrap, temperature sensor, injection port, and a generator connector.

FIG. 3 is a schematic diagram showing a unitized injection electrodewith a flexible active tip, closed distal end with diameter larger thanthe outer diameter of the proximal part of the active tip, a flexibleshaft, an injection port, and a generator connector in an external view.

FIG. 4A is a schematic diagram showing connector in an external view aunitized injection electrode with a flexible active tip, a flexibleshaft depicted in a straight position, an injection port, a generatorconnector, and a moveable stylet.

FIG. 4B is a schematic diagram showing in a sectional view a moveablestylet positioned inside a unitized injection electrode where a coil isused in the construction of the shaft and active tip, where theelectrode has a temperature sensor, injection port, and a generatorconnector.

FIG. 5A is a schematic diagram showing connector in an external view aunitized injection electrode system with a flexible active tip, aflexible shaft depicted in a straight position, an injection port, agenerator connector, and a moveable stylet, where the injection port andgenerator connector are each connected separately by means of adedicated tube to the proximal end of the electrode.

FIG. 5B is a schematic diagram showing in a sectional view a moveablestylet positioned inside a unitized injection electrode where a coil isused in the construction of the shaft and active tip, where theelectrode has a temperature sensor, injection port, and a generatorconnector, and where the injection port and generator connector are eachconnected separately by means of a dedicated tube to the proximal end ofthe electrode.

FIG. 6A is a schematic diagram showing connector in an external view aunitized injection electrode system with a flexible active tip, aflexible shaft, an injection port, a generator connector, and a moveablestylet, where the injection port is integrated into the hub at theproximal end of the electrode.

FIG. 6B is a schematic diagram showing in a sectional view a moveablestylet positioned inside a unitized injection electrode where a coil isused in the construction of the shaft and active tip, where theelectrode has a temperature sensor, injection port, and a generatorconnector, and where the injection port is integrated into the hub atthe proximal end of the electrode.

FIG. 7 is a schematic diagram showing connector in an external view aunitized injection electrode system with a flexible active tip, aflexible shaft, an injection port, a generator connector, and a moveablestylet, where the injection port and generator connector are bothintegrated into the hub at the proximal end of the electrode.

FIG. 8A is a schematic diagram showing in an external view an electrodesystem comprising a flexible catheter and stylet electrode.

FIG. 8B is a schematic diagram showing in a sectional view an electrodesystem comprising a flexible catheter and stylet electrode.

FIG. 9A is a schematic diagram showing in an external view an electrodesystem comprising a flexible catheter and stylet electrode.

FIG. 9B is a schematic diagram showing in a sectional view an electrodesystem comprising a flexible catheter and stylet electrode.

Like reference symbols in the various drawings indicate like elements.

A reference to a figure by its numeric index alone is a reference to allfigures having that numeric index as their prefex; for example, “FIG. 4”refers to FIG. 4A and FIG. 4B collectively.

DETAILED DESCRIPTION

FIG. 1A presents an electrode system comprising injection electrode 160,introducer needle 170, ground pad 184, and generator 180, in accordancewith one aspect of the present invention. Syringe 159 can be attached toport 150 of electrode 160 to provide for the injection of fluids intobody 190 through electrode 160. In one embodiment, the system canprovide for stimulation-guided epidural anesthesia andtemperature-monitored radiofrequency treatment, include pulsedradiofrequency treatment, of nerves. In one embodiment, the system canprovide for the application of high frequency electric fields to nerveby means of placing an electrode via the epidural space. In oneembodiment, the system can provide for the application of high-frequencyelectric fields to nerve by means of placing an electrode via the neuralforamina. In one embodiment, the system can provide for cost-effectivemanufacturing of a catheter electrode configured for placement in theepidural space. In one embodiment, the system can provide forcost-effective manufacturing of a temperature-monitoring catheterelectrode configured for placement in the epidural space. In oneembodiment, the system can provide for the construction of a catheterelectrode capable of delivery of nerve stimulation signals, delivery ofradiofrequency signals, and fluid injection for medical procedures, suchas pain management. In one embodiment, nerve stimulation signalsproduced by generator 180 can be used to position the electrode 160 forthe purpose of an epidural anesthesia procedure, such as lysis ofadhesions, chemical epidural neurolysis, epidural injection of alcohol,and epidural injection of phenol. In one embodiment, the electrode 160can provide for the injection of fluids, such as radiocontrast agents,anesthetics, neurolytics agents, alcohol, phenol, saline, hyaluronidase,local anesthetic, corticosteroids, hypertonic saline. In one embodiment,the electrode tip 100 and shaft 110 can be visible in x-ray images, suchas fluoroscopy. An advantage of this embodiment is that radiographicimaging can be used to position the electrode 160 in the human body 190.In one example, the system can be used to relieve pain. In one example,the system can be used to relieve pain by means of pulsed RF applicationto a dorsal root ganglion. In one example, the system can be used torelieve pain. In one example, the system can be used to relieve pain bymeans of pulsed RF application to spinal nerve. In one example, thesystem can be used to relieve pain due to cancer. In one example, thesystem can be used to relieve pain due to cancer by means ofradiofrequency heat lesioning of a dorsal nerve root. One advantage ofthe application of radiofrequency using an epidurally placed electrodeis that nerve structures at multiple levels of the spine can be targetedby moving the epidural electrode through the epidural space.

Electrode 160 comprises active tip 100, shaft 110, proximal end of theshaft 111, hub 120, cable 131, injection port 150, generator cable 133,and generator connector 140. Introducer needle 170 comprises hub 171 andshaft 172. Generator 180 is connected to leader cable 181 and connector182 to provide for connection to electrode connector 160. Generator 180is connected to leader cable 183 and ground pad 184. Ground pad 184 isplaced on the skin surface of human body 190. Human body 190 has brain191, spinal cord 192, and spinal nerves 193. Electrode 160 is positionedin the human body 190. Electrode 160 enters the human body 190 bypassing through needle 170. Generator 180 can generate an electricalpotential between the ground pad 184 and the electrode 160, and therebyelectrical current flows from the active tip 100 of the electrode 160,through the body 190, to the reference ground pad 184. In one example,electrode 160 is positioned in the epidural space in the human body 190.In one example, electrode 160 enters the epidural space via a median orparamedian approach. In one example, electrode 160 enters the epiduralspace via the sacral hiatus. In one example, electrode 160 enters theepidural space via an intervertebral foramina of the spinal column. Inone example, the active tip 100 of the electrode 160 is positioned neara dorsal spinal nerve root. In one example, the active tip 100 of theelectrode 160 is positioned near a dorsal root ganglion (DRG). In oneexample, the active tip 100 of the electrode 160 is positioned near aspinal nerve.

In one embodiment, the generator 180 is a medical radiofrequencygenerator. In one embodiment, the generator 180 provides fortemperature-controlled radiofrequency and pulsed radiofrequencytreatment of chronic pain. In one embodiment, the generator 180 is ahigh frequency electrical generator. In one embodiment, the generator180 is nerve stimulator. In one embodiment, the generator 180 includes atemperature-measurement circuit.

In one embodiment, the needle 170 is an epidural needle. In oneembodiment, the needle 170 is a tuohy needle. In one embodiment, theneedle 170 has sigmoidal tip geometry, as shown in FIG. 1A. In oneembodiment, the needle 170 is a spinal needle.

The electrode 160 can have one of a number of constructions inaccordance with the present invention. In one embodiment, electrode 160has one of the constructions shown in FIG. 2. In one embodiment,electrode 160 has one of the constructions shown in FIG. 3. In oneembodiment, electrode 160 has one of the constructions shown in FIG. 4.In one embodiment, electrode 160 has one of the constructions shown inFIG. 5. In one embodiment, electrode 160 has one of the constructionsshown in FIG. 6. In one embodiment, electrode 160 has one of theconstructions shown in FIG. 7. In one embodiment, electrode 160 has oneof the constructions shown in FIG. 8, wherein cable 131 is omitted. Inone embodiment, electrode 160 has one of the constructions shown in FIG.8, wherein cable 131 is omitted and port 150 is omitted. The electrode160 can be a unitized injection electrode. The electrode 160 can be acatheter into which a physically-separate electrode is inserted. Theelectrode 160 can be constructed using a spring coil. The electrode 160can include a temperature sensor, such as a thermocouple.

The electrode 160 can be configured for placement in the epidural spaceof a human body 190. The electrode can have a flexible shaft 110 and tip100. The tip 100 can be an uninsulated metallic coil, such as around-wire spring coil, a flat-wire spring coil, a spiral cut metaltube, a laser-cut metal tube. The tip 100 can be stainless steel. Theshaft 110 and tip 100 can include the same coil. The shaft 110 can beelectrically insulated.

FIG. 1A shows one embodiment of cables for an injection electrode 160,wherein a root cable 131 provides a flow path for fluids injected intoport 150 and housing for wires from generator connector 140, port 140provides an opening for injection of fluids, and generator cable 133carries wires from generator connector 150. In one embodiment, fluidsinjection into port 150 flow through the shaft 110 of the electrode andoutflow into the body 190 through the tip 100. In one embodiment, port150 is a luer port.

In one embodiment, needle hub 171 is a port, such as a luer port,through which fluids can be injected. In one embodiment, the needleshaft 172 is partially electrically-insulated with an metallic activetip and can be used as an RF cannula. In one embodiment, the needle 170is an RF cannula.

FIG. 1B presents an electrode system comprising a first injectionelectrode 60, a second injection electrode 65, a first introducer needle70, a second introducer needle 75, and generator 180, in accordance withone aspect of the present invention. Syringe 59 can be attached to port50 of electrode 60 to provide for the injection of fluids into body 90through electrode 60.

Syringe 59 can be attached to port 55 of electrode 65 to provide for theinjection of fluids into body 90 through electrode 65. Electrode 60 isintroduced into the human body 90 through needle 70. Electrode 65 isintroduced into the human body 90 through needle 75. In one embodimentelectrode 60 can be equivalent to electrode 160 in FIG. 1A. In oneembodiment electrode 65 can be equivalent to electrode 160 in FIG. 1A.In one example, Electrodes 60 and 65 can both be placed in the epiduralspace of the same human body at the same time, and electrodes 60 and 65can be connected to opposite poles of the generator 180, and thereby beenergized in a bipolar manner. An advantage of this configuration isthat bipolar RF therapy can be effected in the epidural space of thehuman body 190.

Referring to FIG. 2, meaning FIGS. 2A, 2B, 2C, 2D, and 2E, in accordancewith one aspect of the present invention, a unitized injection electrodeis presented that comprises an active tip 200, an electrically insulatedshaft 210, a hub 220, cables 230, electrical signal connector 240, andinjection port 250. The electrode can be constructed so that its activetip 200, insulated shaft 210, hub 220, cables 230, signal connector 240,and injection port 250 are inseparably connected. The distal end of theelectrode is the end of the active tip 200, and the proximal end of theelectrode is end of the cables 230. Electrode structures that are moredistal are closer to the distal tip 205. Electrode structures that aremore proximal are closer to the generator connector 240 and/or to theinjection port 250.

The active tip 200 is constructed from coil 201 and closed distal end205. The closed distal end 205 can be a weld, which can be formed bylaser, electrical discharge, or other methods known to one skilled inthe art. The closed 205 distal end can be formed with conductive glue.The closed distal end 205 can be created using solder. The close distalend can be formed using glue. The closed distal end 205 can beconfigured to be electrically conductive. The closed distal end 205 canbe configured to be electrically connected to the coil 201. The tip 200can be configured to deliver electrical signals, such as stimulation andRF signals, to tissue, such as nerves. The tip 200 can be configured toallow for the outflow of fluid. The tip 200 can be configured to allowfor preferential outflow of fluid from one or more parts of the tip. Inthe embodiment presented in FIG. 2, the tip 200 has a proximal region202 which is closely-coiled wire. The tip 200 has a middle region 203 inwhich the coils are separated to allow for fluid outflow. For example,the outflow region 203 can have a ratio between wire diameter andinter-wire spacing of 1:1. The tip 200 has a distal region 204 which isclosely-coiled wire. It is understood one or more of the tip regions202, 203, and 204 can be omitted in other embodiments of the electrode.

The closed distal end 205 can have the same outer diameter as the outerdiameter of the rest of the active tip 200. The closed distal end 205can be full radiused. The closed distal end 205 can be hemispherical.The closed distal end 205 can be flat. The closed distal end 205 canhave a smaller diameter than the outer diameter of the rest of theactive tip 200. The closed distal end 205 can have a larger diameterthan the outer diameter of the rest of the active tip 200. In anotherembodiment of the present invention, the distal end 205 can be open; anadvantage of this embodiment is that fluid can exit the electrode fromthe distal end.

The insulated shaft 210 is constructed of electrical insulation 211 thatsurrounds the coil 201 within it. The coil 201 within the shaft can beclosely coiled wire like that of the proximal tip region 202. In oneembodiment, the coil 201 can extend through the entire length of theshaft 210. In one embodiment, the coil 201 can extend only part of thelength of the insulated shaft 210 and connect to another structure thathas different flexibility, such as a tube or a spiral-cut tube. In oneembodiment, the coil 201 can extend though the shaft 210 and the hub220. In one embodiment, the coil 201 can extend though the shaft 210,the hub 220, and the cables 230.

The tip 200 and shaft 210 can be flexible. The tip 200 and shaft 210 canbe configured for placement within the epidural space in the human body.The coil 201 can be a stainless steel spring coil. In one example, thecoil 201 can be a spring coil used in the construction of epiduralcatheters, as is familiar to one skilled in the art of epiduralanesthesia. The coil 201 can be constructed of wound round wire. Thecoil 201 can be constructed of wound flat wire. The coil 201 can belaser-cut tubing. The coil 201 can be laser-cut stainless-steelhypodermic tubing. The electrical insulation 211 can be constructed fromone or more pieces and/or applications of medical grade plastic tubing,fluoropolymers, fluoroelastomers, silicone, polyester, polyolefin,polyimide, and other materials that are familiar to one skilled in theart of RF electrodes and epidural catheters. The electrical insulation211 can be constructed from materials configured to produce shaftstiffness appropriate for epidural placement in the human body. Theelectrical insulation 211 can be a single a tube of fluoropolymermaterial, such as PTFE, FEP, ETFE, PET. The electrical insulation 211can be heat shrink tubing that is shrunk over the coil 201. Theelectrical insulation 211 can be applied by coating the wire of the coil201 before that wire is wound into the coil 201. The electricalinsulation 211 can be PTFE heat shrink tubing that is shrunk over thecoil 201. The electrical insulation 211 can be FEP heat shrink tubingthat is shrunk over the coil 201. The electrical insulation 211 can beETFE heat shrink tubing that is shrunk over the coil 201. The electricalinsulation 211 can be PET heat shrink tubing that is shrunk over thecoil 201. The electrical insulation 211 can consist of two layers ofplastic material that surround the spring coil 201, as is familiar toone skilled in the art of epidural anesthesia catheters. The electricalinsulation 211 can be produced by applying a layer of a first materialto the coil, for example by spraying or painting, and then applying asecond material, such as a tube, over the first material. The coil 201can be wound wire of 0.004 inch diameter. The coil 201 can be wound wireof 0.005 inch diameter. The coil 201 can be wound wire of 0.006 inchdiameter. The coil 201 can be wound wire of 0.007 inch diameter. Thecoil 201 can be wound wire of less than 0.004 inch diameter. The coil201 can be wound wire of greater than 0.007 inch diameter. The outerdiameter of the coil 201 can be in the range 21 gauge to 18 gauge. Theouter diameter of the coil 201 can be smaller than 21 gauge. The outerdiameter of the coil 201 can be larger than 18 gauge. The outer diameterof the coil 201 can be 20 gauge. The outer diameter of the coil 201 canbe 19 gauge. The electrical insulation 211 can have wall thickness inthe range 0.003 inches to 0.008 inches. The electrical insulation 211can have wall thickness less than 0.003 inches. The electricalinsulation 211 can have wall thickness greater than 0.008 inches. Theelectrical insulation 211 can have wall thickness 0.005 inches. Theoutflow section of the coil 203 can have spaces between adjacent coilloops that is substantially equal to the thickness of the wire fromwhich the coil is wound. The outflow section of the coil 203 can havespaces between adjacent coil loops that is in the range 0.003 inches to0.008 inches. The outflow section of the coil 203 can have spacesbetween adjacent coil loops that is less than 0.003 inches. The outflowsection of the coil 203 can have spaces between adjacent coil loops thatis greater than 0.008 inches. The outflow section of the coil 203 canhave spaces between adjacent coil loops that is 0.005 inches. Theoutflow section of the coil 203 can have spaces between adjacent coilloops that is 0.006 inches. The length of the outflow section of thecoil can be in the range 0.100 to 0.140 inches. The length of theoutflow section of the coil can be less than 0.100. The length of theoutflow section of the coil can be greater than 0.140 inches. The lengthof the outflow section of the coil can be 0.120 inches.

In another embodiment of the electrode, more than one segment ofinsulation can be applied along the length of the electrode shaft, withbare coil 201 between each segment; an advantage of this embodiment isthat RF energy can be applied to multiple separated tissue regionswithout applying RF energy directly to intervening regions. In anotherembodiment, a segment of insulation can cover closed end 205 and thedistal end 204 of the tip 200. In another embodiment of the electrode,the insulation can be configured such that at one or more segments ofthe shaft, there is a gap in the insulation on one side of the shaftthat exposes the underlying coil 201, and insulation covers the otheropposite side of the coil; an advantage of this embodiment is that RFenergy can be applied to tissue in contact with only one side of theelectrode.

The tip 200 can have length between 2 mm and 60 mm. The tip 200 can belonger than 60 mm. The length of the active tip 200 can be 5 mm. Thelength of the active tip 200 can be 10 mm. The length of the active tip200 can be 15 mm. The length of the active tip 200 can be 20 mm. Thelength of the active tip 200 can be 25 mm. The length of the active tip200 can be 30 mm. The active tip 200 can have length configured to theapplication of RF signals to nerves for pain management. The active tip200 can have length configured for epidural placement and injection ofepidural anesthetics.

The length of the shaft 210 can be between 12 inches and 33 inches. Thelength of the shaft 210 can be configured for epidural anesthesiaprocedures, as if familiar one skilled in the art. The length of theshaft 210 can be longer than 33 inches. The length of the shaft 210 canbe shorter than 12 inches. The length of the shaft 210 can be 16 inches.The length of the shaft 210 can be configured to reach the L2 vertebrallevel percutaneously and epidurally via the sacral hiatus.

The hub 220 can have a diameter larger than the insulated shaft 210. Thehub 220 can be configured to facilitate rotation of the electrode shaft210 and tip 200. The hub 220 can be omitted and the cables 230 canconnect directly to the shaft 210. The hub 220 can have similar outerdimension and aspect as tuohy-borst adaptors that are typically attachedto the end of epidural catheters, as is familiar one skilled in the art.The hub 220 can have outer diameter in the range 0.250 inches to 0.500inches. The hub 220 can have outer diameter less than 0.250 inches. Thehub 220 can have outer diameter greater than 0.500 inches.

The cable 230 can be flexible. The cable 230 can be rigid. The cable 230can have both rigid and flexible element. The cable 230 can have ahollow inner lumen capable of carrying injected fluids into theelectrode shaft 210 and tip 200. The cable 230 can contain a tubecapable of carrying wires for connection to the jacks on an RFgenerator. In one embodiment, the cables 230 can be construction fromflexible tubes, glue, and wires for connection to the generator. In oneembodiment, the cables 230 can be construction from flexible tubes,glue, a Y-splitter structure, and wires for connection to the generator.In one embodiment, the cable 230 can be constructed like the cable ofthe Cosman CU electrode, sold by Cosman Medical, Inc. In otherembodiments, the cable can be constructed using the systems and methodspresented in U.S. Pat. No. 7,862,563 by E R Cosman Sr and E R Cosman Jr.In the embodiment shown in FIG. 2, the cable 230 has a single root 231that connects to the hub 220, a branch 232 that connects to and carriesfluid from injection port 250, and a branch 233 that connects to andcarries wires from the connector 240.

The electrical signal connector 240 can be configured to carry signalsfrom an RF generator to the active tip 200 of the electrode, as isfamiliar to one skilled in the art. In one embodiment, the connector 240can be configured to connect to a nerve stimulation device The connector240 can be configured to carry sensory nerve stimulation signals, motornerve stimulation signals, thermal RF signals, pulsed RF signals,signals with carrier frequency in the radiofrequency range, signals withcarrier frequency 500 kHz, signals with one component in theradiofrequency range, signals with one component in the range 250-1000kHz. The connector 240 can be configured to carry temperaturemeasurement signal(s) from the electrode to an RF generator or anothertemperature measurement device, as if familiar to one skilled in theart. In the embodiment presented in FIG. 2, the generator plug 240comprises two pins 242 and 243, of which one can both connect to oneoutput pole of an RF generator and to one pole of the RF generator'stemperature sensing circuit, and of which the other can connect to thesecond pole of the RF generator's temperature sensing circuit. Forexample, pin 242 can connect to one lead from a thermocouple orthermistor sensor in the active tip 200 of the electrode, and pin 243can connect to the other lead from the said thermocouple or thermistorsensor in the active tip 200 of the electrode. The connector 240 can beconfigured to carry other signals, such as additional temperaturemeasurement signals, as is familiar to one skilled in the art. In oneembodiment, the connector 240 can have more than two pins. In oneembodiment, the connector 240 can have three pins. In one embodiment,the connector 240 can have at least three pins, of which one carriestherapeutic and/or diagnostic signals from a generator to the electrode,and the other two connect to a thermocouple contained in the electrode.

The injection port 250 can be configured to carry injected fluids intoand through the cables 230, the hub 220, the shaft 210, and out the tip200. The injection port 250 can be configured to aspirate fluids fromthe electrode tip 200, for example to confirm proper placement of theelectrode tip 200, as is familiar one skilled in the art of epiduralanesthesia. The injection port can be a female luer injection port. Theport 250 can have a luer lock. The port 250 can have a cap. The cable232 connecting the luer injection port can have an external clamp toprevent outflow of fluids.

FIG. 2A presents one embodiment of the present invention in which theshaft 210 and tip 200 are positioned in one example of a flexedposition.

FIG. 2B presents the electrode shown in FIG. 2A, where its flexible tip200 and flexible shaft 210 are in substantially straight position.

FIG. 2C, FIG. 2D, and FIG. 2E presents three embodiments of the internalconstruction of the electrode from FIGS. 2A and 2B, shown incross-sectional views. Referring now to FIG. 2C, FIG. 2D, and FIG. 2E,the coil 201 is shown in a cross-sectional view wherein round-wire windsappear substantially elliptical. In another embodiment of coil 201, thecross-section of the coil 201 does not appear as an ellipse, for exampleif flat wire is used to construct the coil 201, the cross section has asubstantially rectangular. In one example, the coil 201 is a stainlesssteel spring coil, which is familiar to one skilled in the art ofepidural catheters. The closed distal end 205 of the tip 200 is shown incross-section. The insulation 211 is shown in a cross-sectional viewwherein its tubular structure appears on both sides of the coil 201. Inone example, the insulation 211 is a flexible plastic tube, familiar toone skilled in the art of epidural catheters. In one example, theinsulation 211 is constructed from a flexible plastic tube within whichis another coating, as is familiar to one skilled in the art of epiduralcatheters. The hub 220 is shown in cross-section wherein its tubularstructure appears on both sides of the insulation 211 and the tubing234. In one example, the hub 220 is a rigid structure composed of aplastic tube and glue that prevents fluid leakage out from the coil 201,insulation 211, and injection tube 234.

The injection tube 234 is shown in a cross-sectional view wherein itstubular structure appears on opposite sides of the central lumen of theinjection branch 232 and the root 231 of the cable 230. The injectiontube 234 connects the injection port 250 and the hub 220. The injectiontube 234 provides a channel through which fluids injected into theinjection port 250 can flow into the shaft 210, into the tip 200, andthen out from spaces between the coil loops of the tip 200,preferentially through the larger gaps between coil loops in the outflowsection 203 of the tip 200. The injection port 250 is shown in across-sectional view wherein it appears on opposite sides of the openingat the end of the injection port branch 232 of the cable 230. The port250 can be a female luer connector. The connector branch 233 of thecable 230 is shown in cross-sectional view so that its walls appear onopposite sides of the internal space through which wires 236 and 237travel from the generator connector 240 into the root 231 of the cable230. The connector 240 is shown in a cross-sectional view wherein pins242 and 243 and mounted within the body 241, which appears in threeparts around and between the pins 242 and 243. It is understood that thewires 236 and 237 can each be constructed from multiple pieces of wire,rod, tubing, solder joints, crimps, hooks, and other elements familiarto one skilled in the art of medial device manufacturing.

The wall 235 of the injection tube 234 limits fluid flow into theconnector branch 233 of the cable 230. It is understood that this wallportion 235 can, in another embodiment, be constructed of a differentmaterial from that of the tube 234; for example, from a glue plug. Thewires 236 and 237 travel through the wall 235. It is understood thatother embodiments of the construction of the cables 230 can be used toprovide both connection to a generator and a pathway for injection offluids. For example, the cable constructions presented in U.S. Pat. No.7,862,563 by E R Cosman Sr and E R Cosman Jr can be used. For example,the cable 230 can be constructed like the cable of the Cosman CUelectrode, sold by Cosman Medical, Inc.

The wire 236 can be configured to carry electrical signal output from anRF generator and/or a stimulation waveform generator. The wire 236 canbe composed of a conductive material, such as copper. The wire 236 canbe coated with an electrical insulator. The wire 236 can be bare. Thewire 236 can be configured to connect via pin 242 to both the electricalsignal output of a generator, such as an RF generator, and to the firstterminal of a temperature-monitoring circuit, which can be integratedinto the same generator or which can be housed in a separate unit. Thewire 237 can be configured to connect via pin 243 to the second terminalof the said temperature monitoring circuit. The wire 237 can be anelectrically-insulated constantan wire. In another embodiment, pin 242connects to the electrical signal output of a generator, wire 236carries signals from the output of said generator, pin 243 has isolatedprongs each of which connects to a isolated terminal of atemperature-monitoring circuit, and wire 237 is an bifilar thermocouplewire, such as a copper-constantan bifilar.

Referring now specifically to FIG. 2C, the unitized injection electrodeincludes a central wire 260 within the inner lumen of the coil 201. Thecentral wire 260 can be configured to stiffen the shaft 210 and the tip200 of the electrode. The central wire 260 can be configured to providesufficient stiffness for epidural placement of the electrode, andlimited stiffness to prevent puncture of sensitive structures around theepidural space, as is familiar to one skilled in the art of epiduralcatheters. The central wire 260 can be a stainless steel rod. Thecentral wire 260 can be copper. The central wire 260 can be a taperedmetal rod. The central wire 260 can be a rod with a substantiallycircular cross section. The central wire 260 can be a hollow tube. Thecentral wire 260 can be a plastic rod. The central wire 260 can be a rodwith a substantially rectangular cross section. The central wire 260 canbe electrically conductive. The central wire 260 can be electricallyinsulative. The rod 260 can be a bare metal structure. The rod 260 canbe covered by an electrically-insulative coating. The central wire 260can have an outer dimension in the range 0.001″ to 0.016″. The centralwire 260 can have an outer diameter 0.010″. The central wire can have anouter diameter 0.011″. The central wire 260 can have an outer diameter0.012″. The central wire can have an outer diameter 0.013″. The centralwire 260 can have an outer diameter 0.014″. The central wire can have anouter diameter greater than 0.016″. The central wire 260 can have anouter diameter configured to fit within the coil 201 and to allowinjected fluid to flow from one end of the coil to the other. Thecentral wire 260 can be configured to conduct electrical signals, suchas high frequency signals, RF output, and nerve stimulation signals,from a generator to the tip 200 of the electrode. The central wire 260can be configured to reduce the impedance of electrical potentials, suchas high frequency electrical waveforms, radiofrequency potentials, andnerve stimulation waveforms, between the generator connector 240 and theuninsulated metallic electrode tip 200. The dimensions of the centralwire 260 can be configured to provide a flow path of desired area forinjected fluids along the electrode shaft.

The central wire 260 can be attached at the distal end of the coil 201and at the proximal end of the coil 201; one advantage of thisembodiment of the invention is that the central wire 260 preventsextension of the coil 201 if its distal end 204 or the closed end 205 iscaught in some anatomy, such as between two vertebra. The central wire260 can carry electrical signals from the generator to the tip 200 ofthe coil 201; one advantage of this of this embodiment of the inventionis that it reduces the electrical impedance between the generator andthe active tip 200 of the electrode. The central wire 260 can beconfigured to maintain a bent configuration. The central wire 260 can beconfigured to maintain a bent configuration when bent by the user, suchas a physician. An advantage of central wire 260 holding a bend is thata bend can be imposed in the electrode shaft. An advantage of a bentelectrode shaft is that the bend can maneuvering of the electrode in thehuman body, such as in the epidural space.

The central wire 260 is connected at junction 263 to both the proximalend of the coil 201 and to the wire 236. The junction 263 can beelectrically conductive. The junction 263 can create an electricallyconnection between the wire 263 and the coil 201. The junction 263 cancreate an electrical connection between the wire 263 and the central rod260. The junction 263 can be configured to transmit electrical signalsfrom the wire 263 to the coil 201, either by direct electricalconnection of the wire 263 to the coil 201, by electrical connectionbetween the wire 263 and rod 260 and then electrical connection betweenthe rod 260 and the coil 201 at junction 261, or both. In one example,the junction 263 is a solder joint. In another example, the junction 263includes both a weld and a solder joint. In another example, thejunction 263 includes glue. In another example, the junction 263includes a mechanical lock. In another example the junction 263 is aweld, such as a laser weld. In one example, the junction 263 is a solderjoint that incorporates the coil 201, the wire 236, and the central wire260. In another example, the junction 263 is a solder joint between thewire 236 and the central wire 260, and the central wire 260 isconfigured so that it mechanically locks with the coil 201; forinstance, the central wire 260 can be folded over on itself so that ithooks around the proximal end of the coil 201. In another example, thejunction can be a laser weld between the central wire 260 and the coil201, and a solder joint between the wire 236 and the coil 201. It isunderstood that the junction 263 can take other forms as is familiar toone skilled in the art of medical device manufacturing. In anotherembodiment, the central wire 260 can be anchored to another element ofthe hub 220.

The central wire 260 is connected to the closed distal end 205 of thetip 200 at junction 261. The junction 261 can be electricallyconductive. The junction 261 can be electrically insulative. Thejunction 261 can be configured so that the rod 260 and the closed distalend 205 connected electrically. In one example, the junction 261 is partof the weld that formed the closed distal end 205. It is understood thatthe junction 263 can take other forms as is familiar to one skilled inthe art of medical device manufacturing, including without limitation,gluing, welding, soldering, crimping, hooking, mechanical locking.

The wire 237 is connected to the closed distal end 205 of the tip 200 atjunction 262. The junction 262 can be electrically conductive. Thejunction 262 can be electrically insulative. The junction 262 can beconfigured so that the rod 260 and the closed distal end 205 connectedelectrically. In one example, the junction 262 is part of the weld thatformed the closed distal end 205. It is understood that the junction 263can take other forms as is familiar to one skilled in the art of medicaldevice manufacturing, including without limitation, gluing, welding,soldering, crimping, hooking, mechanical locking. In one embodiment thewire 237 is an insulated constantan wire, the coil 201 is stainlesssteel, and the junction 262 is electrically conductive such that itforms a thermocouple junction. In one embodiment the wire 237 is aninsulated metal wire, the coil 201 is composed of a dissimilar metal,and the junction 262 is electrically conductive such that it forms athermocouple junction. In one embodiment, the closed distal end 205 is aweld that incorporates both the wire 237 and the coil 201. In oneembodiment, the closed distal end 205 is a solder joint thatincorporates both the wire 237 and the coil 201. In one embodiment, thewire 237 is a thermocouple bifilar, such as a copper-constantan bifilar,as is familiar to one skilled in the art of thermocouples, and thejunction includes an element that forms the thermocouple junctionbetween the two wires of the bifilar 237, for example by means of aweld, and an element that mechanically attaches the distal end of thebifilar wire 237 to the closed end of the coil 205.

It is understood in different embodiments that the wire 237 can take anyone of a number of paths along the shaft 210, for example, entirelywithin the coil inner lumen, between the coil 201 and insulation 210, orpassing into the inner lumen and out into the space between theinsulation 211 and the coil 201 by passing between adjacent loops of thecoil 201 any number of times.

In one example, the closed end of the coil is a weld that connects thewire 237, the rod 260, and the coil 201. In one example, the closed endof the coil is a solder joint that connects the wire 237, the rod 260,and the coil 201.

In one example, the wire 236, the central wire 260 and the coil 201itself carry electrical output of an electrosurgical generator, such asradiofrequency and/or stimulation waveforms, to the tip 200 of theelectrode. In one example, wires 236 and 237 connect to opposite polesof a temperature sensor, such as a thermocouple junction, at the tip 200of the electrode, and conduct signals from said temperature sensor to atemperature monitoring system.

In another embodiment, the temperature connection 243, the wire 237, andthe junction 262 can be omitted. In this embodiment, electrical signalsare conducted through the electrode without temperature monitoring. Anadvantage of this embodiment is that it is easier to build. An advantageof this embodiment is that the electrode provides for stimulation-guidedplacement in the epidural space. An advantage of this embodiment is thatit can be used for non-temperature-monitored application of RF therapy,such as thermal RF lesioning and pulsed RF treatment.

In one embodiment of the present invention, an example of which is shownin FIG. 2C, the unitized electrode is configured for placement in theepidural space, temperature monitoring of the electrode's active tip,and delivery of radiofrequency signals via the electrode's active tip;wherein the electrode consists of a metallic coil with a proximal anddistal end, an electrically insulative sheath that covers the proximallength of the coil and leaves the distal end of the coil exposed, atemperature sensor in exposed distal end of the coil, a port that allowsfor injection of fluids into the inner lumen of the coil, and aconnector to an electrosurgical generator. In a more specificembodiment, the unitized electrode includes a central wire thatmechanically connects the distal end of the coil to proximal hubstructures. In a more specific embodiment, the said spring coil isstainless steel. In a more specific embodiment, a thermocouple junctionis formed at the distal tip of the electrode by welding a constantanwire to the coil and to the central metallic wire.

Referring now to FIG. 2D, the unitized injection electrode includes acentral wire 270. In this embodiment, junction 273 connects the centralwire 270 and the wire 236, and junction 271 connects the central wire270 to the closed distal end 205 of the active tip 200. Junction 272 isthe connection of the wire 237 to the closed distal end 205 of theactive tip 200. In one embodiment, high frequency electrical signals arecarried to the active tip 200 of the electrode via wire 236 and rod 270.In one embodiment, the junction between wires 237 and 270 at the closeddistal end 205 form a thermocouple junction. In one embodiment, the wire236 is a bifilar wire that carries signals from a temperature sensor atjunction 272. The junction 273 and wire 236 can be configured to anchorthe rod 270 to the generator connector; an advantage of thisconfiguration is that the wire 270 prevents the tip 200 from separatingfrom the electrode. The junction 273 can include elements familiar toone skilled in the art of medical device construction, includingsoldering, welding, crimping, clamping, gluing, hooking, and twisting.In one example, the rod 270 is cover by electrically insulation alongits length, so that signals carried by wire 236 are not conveyed to theclosed distal end 205 by the coil 201. In another example, the rod 270is uninsulated so that electrical signals are carried to the active tip200 via the coil 201 if the coil touches the central wire 270. Thecentral wire 270 can be a metal rod. The central wire 270 can be a flatwire with rectangular cross section. The central wire 270 can have outerdiameter at a value in the range 0.001 to 0.018 inches. The central wire270 can have outer diameter 0.011 inches. The central wire 270 can havea rectangular cross section with cross section substantially similar to0.003 inches by 0.009 inches. The central wire 270 can be dimension andgeometry configured to provide desired separation force between the tip200 and the hub 220. The central wire 270 can be dimension and geometryconfigured to provide desired separation force between the distal end ofthe coil 201 and the proximal end of the coil 201. The central wire 270can be configured to produce a desired flexibility for the shaft 210 andtip 200. The central wire 270 can be configured to maintain a bentconfiguration. The central wire 270 can be configured to maintain a bentconfiguration when bent by the user, such as a physician. An advantageof central wire 270 holding a bend is that a bend can be imposed in theelectrode shaft. An advantage of a bent electrode shaft is that the bendcan maneuvering of the electrode in the human body, such as in theepidural space. The central wire 270 can be configured so that theelectrode is suitable for placement in the epidural space.

Referring now to FIG. 2E, the unitized injection electrode includes asafety strap 280. The safety strap 280 is connected to the distal end ofthe coil 201 at junction 281 and to the proximal end of the coil 201 atjunction 283. The wire 236 is connected to the coil 201 at junction 283.The wire 237 is connected to the distal end of the coil 201 at junction282. The wire 236 and the coil 201 itself can carry RF output and/orstimulation output to the active tip 200 of the electrode from a medicalelectrosurgical generator to which connector 240 is attached. In oneembodiment, the junction between the spring coil 201 and the wire 237 atthe closed distal end 205 of the coil 201 forms a temperature sensor,such as a thermocouple, and the wires 236 and 237 carry signals fromsaid temperature sensor to the connector 240. In another embodiment, thewire 237 is a bifilar wire, such as a copper-constantan thermocouplewire, and junction 272 is a temperature-sensing junction, such as athermocouple weld, that is mechanically anchored to the tip 200. Thesafety strap 280 can be a metal rod. The safety strap 280 can be a flatwire with rectangular cross section. The safety strap 280 can have outerdiameter at a value in the range 0.001 to 0.018 inches. The safety strap280 can have outer diameter 0.010 inches. The safety strap 280 can havea rectangular cross section with cross section substantially similar to0.003 inches by 0.009 inches. The safety strap 280 can be dimension andgeometry configured to provide desired separation force between the tip200 and the hub 220. The safety strap 280 can be dimension and geometryconfigured to provide desired separation force between the distal end ofthe coil 201 and the proximal end of the coil 201. The safety strap 280can be configured to produce a desired flexibility for the shaft 210 andtip 200. The safety strap 280 can be configured to maintain a bentconfiguration. The safety strap 280 can be configured to maintain a bentconfiguration when bent by the user, such as a physician. An advantageof safety strap 280 holding a bend is that a bend can be imposed in theelectrode shaft. An advantage of a bent electrode shaft is that the bendcan maneuvering of the electrode in the human body, such as in theepidural space. The safety strap 280 can be configured so that theelectrode is suitable for placement in the epidural space.

FIG. 3 presents a unitized injection electrode for which the closeddistal end 305 has a larger outer diameter than the outer diameter ofthe rest of the active tip 300, in accordance with one aspect of thepresent invention. In one embodiment, the electrode in FIG. 3 isanalogous to the electrode presented in FIG. 2. The electrode comprisesa flexible active tip 300, an electrically-insulated flexible shaft 310,a hub 320, cables 330, electrical signal connector 340, and injectionport 350. The electrode can be constructed so that its active tip 300,insulated shaft 310, hub 320, cables 330, signal connector 340, andinjection port 350 are inseparably connected. The distal end of theelectrode is the end of the active tip 300, and the proximal end of theelectrode is end of the cables 230. As in the electrode presented inFIG. 2A, in one embodiment, the tip 300 and shaft 310 include a coil301, and electrical insulation 311 covers the coil in the shaft region310 and is absent in the tip region 300, to form the metallic active tip300 of the electrode. The tip includes an outflow region 303 that can beconfigured to preferentially emit fluids injected into the port 350. Theactive tip 300 can be configured to be energized by a generator attachedto connector 340. Temperature can be measured at the active tip 300 by atemperature measurement circuit attached to the connector 340. Thelength of the electrode's shaft 310 can be configured for epiduralplacement. The length of the electrode's active metallic tip 300 can bein the range 2-30 mm or more, and it can be configured by performing RFand pulsed RF therapy.

FIGS. 4A and 4B each present a unitized injection electrode with movablestylet 460, in accordance with one aspect of the present invention. Theelectrode with stylet 460 can be configured for placement in theepidural space. Referring to both FIG. 4A and FIG. 4B, the stylet 460comprises a hub 461 and shaft 462. The electrode, within which thesytlet 460 can move, comprises an active tip 400, an electricallyinsulated shaft 410, a hub 420, cables 430, electrical signal connector440, and injection port 450. The electrode can be constructed so thatits active tip 400, insulated shaft 410, hub 420, cables 430, signalconnector 440, and injection port 450 are inseparably connected. InFIGS. 4A and 4B, the sylet 460 is shown positioned within the unitizedinjection electrode. The tip 400 can be constructed from a metallic coil401, such as stainless steel spring coil, and have regions of tightcoiling 402 and 404, and regions of looser coiling 403 to allow forpreferential outflow of fluids injection into port 450, and a closeddistal end 405 that is, in one embodiment, blunt and atraumatic. Thecoil 401 can extend into the shaft region 410, where it is covered byelectrical insulation 411. The active tip 400 can be configured to beenergized by a generator attached to connector 440. Temperature can bemeasured at the active tip 400 by a temperature measurement circuitattached to the connector 440. The stylet hub 461 can be configured tobe grasped by human fingers. The stylet hub 461 can be omitted. Theelectrode hub 420 can be omitted. The length of the electrode's shaft410 can be configured for epidural placement. The length of theelectrode's shaft 410 can be in the range 12 to 33 inches. The length ofthe electrode's active metallic tip 400 can be in the range 2-30 mm ormore, and it can be configured by performing RF and pulsed RF therapy.The diameter of the electrode shaft 410 and tip 400 can be in the range21 gauge to 18 gauge. Electrode shaft 410 and tip 400 can besubstantially equal to 19 gauge. Electrode shaft 410 and tip 400 can besubstantially equal to 20 gauge. Electrode shaft 410 and tip 400 canconfigured for epidural placement.

The distal end of the electrode is the end of the active tip 400, andthe proximal end of the electrode is end of the cables 430. Electrodestructures that are more distal are closer to the distal tip 405.Electrode structures that are more proximal are closer to the generatorconnector 440 and/or to the injection port 450. The distal end of thestylet 460 is the distal tip 463. The proximal end of the stylet 460 isthe handle 461.

When inserted, the stylet 460 can enter the port 450, travel throughbranch 432 and 431 of the cables 430, the hub 420, shaft 410, and all,part, or none of the tip 400. In one embodiment, not shown, the cablebranches 431 and 432 can present a straight path through which thestylet moves. In one embodiment, the cable branches 431 and 432 can berigid in whole or in part to facilitate movement of the stylet shaft 462within them. In one embodiment the cable branch 433 that is associatedwith the generator connector 440 is flexible. In another embodiment thecable branch 433 that is associated with the generator connector 440 isrigid.

The shaft 410 and tip 400 can both be flexible when the stylet 460 isinserted and when the stylet 460 is not inserted. The stylet can bephysically separable 460 from the electrode. An advantage of theembodiment where the stylet 460 can be fully withdrawn and removed fromthe electrode is that when the stylet is fully removed from theelectrode, fluids can be injected into port 450 and delivered to anatomynearby the electrode tip 400. The stylet 460 can be physicallyinseparable from the electrode, for example, by providing a mechanicalelement that prevents removal of the stylet from the electrode. Theelectrode and stylet 460 can be configured to enable the user to movethe stylet 460 within the inner lumen of the electrode; an advantage ofa unitized injection electrode with a moveable stylet 460, is that thestylet 460 can be moved to adjust the flexibility of the electrode tip400 and shaft 410. The electrode and stylet 460 can be configured forplacement in the epidural space of the human body. The electrode can beconfigured to provide for radiofrequency treatment and injection offluids, such as radiocontrast agents, anesthetics, neurolytics agents,alcohol, phenol, saline, hyaluronidase, local anesthetic,corticosteroids, hypertonic saline. The electrode can be configured tomonitor the temperature at the tip 400 of the electrode. The electrodeand stylet 460 can be configured for stimulation-guided epiduralanesthesia, such as lysis of adhesions. The electrode can be configuredto be radiopaque. The stylet shaft 462 can be configured to beradiopaque. An advantage of the electrode being radiovisible is thatx-ray guidance, such a fluoroscopy, can be used to position theelectrode in the human body. An advantage of the stylet 460 beingradiovisible is that x-ray guidance, such a fluoroscopy, can be used toposition the electrode in the human body. The construction of the stylet460 can be that of epidural catheters. The stylet shaft 462 can be astainless steel rode. The stylet shaft 462 can have outer diameter thatis a value in the range 0.001 inches to 0.018 inches. The stylet shaft462 can have outer diameter greater than 0.018 inches. The stylet shaft462 can have outer diameter that is 0.010 inches. The stylet shaft 462can be configured to be flexible enough to move through the cables 430,shaft 410, and tip 400. The stylet shaft 462 can be configured tomaintain a bent configuration. An advantage of the sytlet 460 holding abend is that a bend can be imposed in the electrode shaft when thestylet 460 is in place. An advantage of a bent electrode shaft is thatthe bend can maneuvering of the electrode in the human body, such as inthe epidural space.

Referring now to FIG. 4A, an external view of a unitized injectionelectrode and stylet 460 is shown.

Referring now to FIG. 4B, a cross-section of the unitized injectionelectrode is presented and shows one embodiment of its construction. Theshaft 462 of the stylet 460 is within the inner lumen of the coil 401,which appears as a series of substantially circular elements in thecross-sectional view. The tip of the stylet 463 can touch the innersurface of the electrode's distal end 405 when the stylet is fullyinserted. The tip of the stylet 463 can be configured so that is cannottouch the inner surface of the electrode's distal end 405 when thestylet is fully inserted. One advantage of the distal tip of thestylet's 463 not being able to touch the inner surface of theelectrode's distal end when fully inserted is that it ensures the distalend of the coil 401, for instance the region 404, is less stiff than therest of the tip 400 and shaft 410 at all times.

Pin 442 of connector 440 can be configured to connect to the electricaloutput of a medical electrical generator, such as an RF generator or anerve stimulator. Pin 442 is connected to wire 436. Wire 436 isconnector to the coil 401 and the safety strap 480 at junction 484.Safety strap 480 is connected to the coil 401 at its distal end 405 atjunction 481. Pin 442, wire 236, coil 401, strap 480 can be configuredto carry electrical signals, such as RF generator output, to the activetip 400 of the electrode from a medical generator connected to pin 442.In another example, the safety strap 480 can be electrically insulative.The wire 436 can include a conductive metal, such as copper. The safetystrap 480 can include a conductive metal, such as stainless steel. Thesafety strap 480 can be a stainless steel flat wire. The cross-sectionof the safety strap can be substantially rectangular with dimensionsubstantially similar to 0.005 inches by 0.010 inches. One advantage ofthe safety strap 480 being a flat wire is that the safety strap 480 hasa low profile. One advantage of the safety strap 480 being a flat wireis that the safety strap 480 obstructs less of the fluid flow pathwithin the lumen of the coil 401. One advantage of the safety strap 480being a flat wire is that a larger diameter stylet shaft 462 can passedinto the inner lumen of the coil 401. The safety strap 480 can beconfigured to help prevent the coil 401 from changing length and/oruncoiling within the body. In another embodiment, the safety strap 480can be omitted, in which case junction 484 is between wire 436 and coil401, and the coil 401 itself carries electrical signals to its activetip 400.

In one embodiment pin 443 connects to one pole of temperature-monitoringcircuit and pin 442 connects to the other pole of saidtemperature-monitoring circuit. In this embodiment, wire 437 connects topin 443 and is electrically-insulated constantan wire, and the safetystrap 480 and coil 401 can both be stainless steel. The distal end ofthe coil 405 can be a weld that connects the coil 401, the strap 480,and the constantan wire 237 to form a thermocouple junction from whichthe said temperature-monitoring circuit measures temperatures. Inanother embodiment, pin 443 has two electrically-isolated prongs thatconnect to both poles of a temperature-monitoring circuit, the wire 437is a bifilar of dissimilar metals, such as copper-constantanthermocouple wire, the junction 482 is the thermocouple formed byconnection of the two wires of the bifilar 437 to form a thermocouple,and the temperature-monitoring circuit measures temperature from thethermocouple 482; the thermocouple 482 can be connected to the coil 401within the length of the tip or to its closed distal end 405.

It is understood, that the wire 437 can be positioned outside the coilfor all or part of the length of the hub 420 and shaft 411. It isunderstood, that the wire 437 can pass into and out of the coil 401along its length by passing between adjacent loops of the coil 401. Oneadvantage of the wire 437 being outside the inner lumen of the coil 401is that it is like likely to be damaged by the movable stylet shaft 462.

FIG. 5 presents a unitized injection electrode with moveable stylet inaccordance one aspect with the present invention. FIG. 5A shows anexternal view of the unitized injection electrode. FIG. 5B shows oneembodiment of the internal construction of the unitized injectionelectrode in a cross-section view. In one embodiment, the embodimentspresented in FIG. 5A and FIG. 5B are analogous to the embodimentspresented in FIG. 4A and FIG. 4B, with the difference that in FIG. 5,the injection cable branch, labeled 532 in FIG. 5 and labeled 432 inFIG. 4, and the generator cable branch, labeled 533 in FIG. 5 andlabeled 433 in FIG. 4, are connected directly to the hub, labeled 520 inFIG. 5 labeled 420 in FIG. 4, whereas in FIG. 4 the injection cablebranch and generator cable branch connect to a root cable branch 431that connects to the hub 420. In one embodiment, the injection electrodewith moveable stylet is configured for RF therapy. In one embodiment,the injection electrode with moveable stylet is configured to be placedin the epidural space. In one embodiment, the injection electrode withmoveable stylet 560 is configured for injection of fluid through the tip500. In one embodiment, the stylet 560 can be removed from the electrodeto allow for delivery of fluids from the tip 500 by means of injectioninto port 550. In one example, the electrode shaft 510 and tip 500 areflexible. In one embodiment, the injection electrode is configured tomeasure the temperature of tissue in contact with the active tip 500 ofthe electrode. In one embodiment, the injection electrode is configuredto effect temperature-controlled radiofrequency treatment, includingpulsed radiofrequency therapy, of nerves by means of placement of theelectrode in the epidural space of a human patient in order to managesaid patient's pain. In one embodiment, the unitized injection electrodewith moveable stylet is configured to apply radiofrequency electricfields, including pulsed radiofrequency electric fields, to spinalnerves, spinal nerve roots, dorsal spinal nerve roots, and/or dorsalroot ganglia, by placement of the electrode in the epidural space and/orthe spinal foramina.

The distal end of the electrode is the end of the active tip 500, andthe proximal end of the electrode is end of the cables 530. Electrodestructures that are more distal are closer to the distal tip 505.Electrode structures that are more proximal are closer to the generatorconnector 540 and/or to the injection port 550. The distal end of thestylet 560 is the distal tip 563. The proximal end of the stylet 560 isthe handle 561.

The unitized injection electrode has tip 500 comprising a metallic coil501 with distal end 505, shaft 510 comprising electrical insulation 511covering the metallic coil 501, hub 520, generator cable 533, connector540 comprising body 541 and pins 542 and 543, injection cable 532,injection port 550, and movable stylet 560 comprising hub 561 and shaft562. In one embodiment, elements 500, 510, 520, 533, 540, 532, and 550are inseparably connected. In one embodiment injection tube 532 isstraight. In one embodiment injection tube 532 is curved. In oneembodiment injection tube 532 is flexible. In one embodiment injectiontube 532 is rigid. In one embodiment generator cable 533 is flexible. Inone embodiment generator cable 533 is rigid. In one embodiment, thestylet shaft 562 is a metal rod. In one embodiment, the stylet shaft 562is a strainless steel rod. In one embodiment, the stylet shaft 562 is anitinol rod. One advantage of a moveable stylet 560 is that theflexibility of the electrode shaft 510 and tip 500 can be adjusted bymovement of the stylet 560.

In another embodiment, the injection tubing 532 can be omitted and theinjection port 550 directly connected to the hub 520. In anotherembodiment, the generator cable 533 can be omitted and the connector 540directly connected to the hub 520. In another embodiment, the hub 520can be omitted, and the injection cable 532 and the generator cable 533directly connected to the electrode shaft 510. In another embodiment,the hub 520 can be omitted, the injection tube 532 omitted, theinjection port 550 directly connected to the electrode shaft 510, andthe generator cable 533 directly connected to the electrode shaft 510.In another embodiment, the hub 520 can be omitted, the electrode cable532 omitted, the injection tube 532 directly connected to the electrodeshaft 510, and the generator connector 540 directly connected to theelectrode shaft 510. In another embodiment, the hub 520 can be omitted,the electrode cable 532 omitted, the injection tube 532 omitted, theinjection port 550 directly connected to the electrode shaft 510, andthe generator connector 540 directly connected to the electrode shaft510. In another embodiment, the injection tube 532 and the injectionport 550 can be omitted, the stylet 560 can be inserted directly intothe inner lumen of the coil 501, and a separate injection port, such asa tuohy-borst adaptor, can be connected to the shaft when the stylet 560is withdrawn from electrode to provide for injection of fluid throughthe electrode into tissue in which the electrode tip is placed.

Referring now to FIG. 5A specifically, an external view of the electrodeis shown with the stylet 560 in place within the electrode.

Referring now to FIG. 5B specifically, a cross-sectional view of oneembodiment of the internal construction of the electrode is shown withthe stylet 560 in place within the inner lumen of the electrode. In oneembodiment, the stylet shaft 562 is configured so that when it fullyinserted into the electrode, the distal tip 563 of the stylet shaft 562contacts the inner surface of the distal tip 505 of the electrode. Inanother embodiment, the stylet shaft 562 is configured so that when itfully inserted into the electrode, the distal tip 563 of the styletshaft 562 is does not contact the inner surface of the distal tip 505 ofthe electrode. Element 535 is configured to limit or prevent the flow offluid into the generator cable 533. Wire 536 and 537 pass throughelement 535. In one embodiment, element 535 includes the wall of theinjection tube 532. In one embodiment, element 535 includes glue, suchas a glue plug. In one embodiment, element 535 includes the wall of theshaft insulation 511. In one embodiment, wire 537 can passes into theinner lumen of the coil 501 via its proximal end, as illustrated in FIG.5B. In another embodiment, wire 537 can enter the inner lumen of coil501 by passing between links of the coil 501. Pin 542 is electricallyconnected to wire 536, which is electrically connected to coil 501 atjunction 583, which can be, for example, a weld or solder joint. In oneembodiment, electrical output from a generator connected to pin 542 isconducted to the active tip 500 of the electrode via wire 536, junction583, and coil 501. Pin 543 is electrically connected to wire 537, whichis connected to the distal end 505 of the electrode at junction 582. Inone embodiment, distal end 505 is a weld that incorporates the wire 537.In one embodiment, distal end 505 is a solder joint that incorporatesthe wire 537. In one embodiment, distal end 505 is a glue joint thatconnects to the wire 537. In one embodiment, wire 537 is a constantanwire, the coil 501 is stainless steel, the connection between the coil501 and the wire 537 is a thermocouple junction, pin 542 is configuredto be attached to a temperature-measurement circuit, pin 542 isconfigured to be attached to the same temperature-measurement circuit,and thereby the temperature of tissue in contact with the distal tip 505of the electrode. In another embodiment, wire 537 comprises insulatedconstantan and copper wires whose junction 582 is a thermocouplejunction, pin 543 comprises two electrically-isolated pins of which eachis connected tone of the two wires comprising wire 537, said twoelectrically-isolated pins are configured to be connected to atemperature-measurement system, and thereby the temperature of tissue incontact with the electrode tip 500 can be measured. The safety strap 580can connect to the distal and proximal end of the coil 501 at junctions581 and 584, respectively. One advantage of the safety strap 580 is thatit makes the shaft 510 and tip 500 more robust. In one embodiment, thesafety strap 580 can be metallic, such as a stainless steel flat wire.One advantage of a metallic safety strap 580 is that it reduces theelectrical impedance between the proximal and distal ends of the coil501. One advantage of a metallic safety strap 580 is that electricalsignals are conducted with less distortion from wire 536 to the activetip 500 of the electrode. In another embodiment, the safety strap 580can be omitted. In another embodiment, the wire 537 can includeelements, such as a wire, that is configured to serve as a safety strap.

FIG. 6 presents a unitized injection electrode with moveable stylet, inaccordance with one aspect of the present invention. FIG. 6A shows anexternal view of the unitized injection electrode. FIG. 6B shows oneembodiment of the internal construction of the unitized injectionelectrode in a cross-section view, with the exterior of the stylet 660shown. In one embodiment, the embodiments presented in FIG. 6A and FIG.6B are equivalent to the embodiments presented in FIG. 5A and FIG. 5B,with the difference that the injection cable branch labeled 532 in FIG.5 is omitted in FIG. 6, and the injection port, labeled 550 in FIG. 5and labeled 650 in FIG. 6, is directly connected to the hub 620 in FIG.6. One advantage of the direct connection of the injection port 650 tothe hub 620 the pathway for fluid injection can be reduced.

The unitized injection electrode has tip 600 comprising a metallic coil601 with distal end 605, shaft 610 comprising electrical insulation 611covering the metallic coil 601, hub 620, generator cable 633, connector640 comprising body 641 and pins 642 and 643, injection port 650, andmovable stylet 660 comprising hub 661 and shaft 662. In one embodiment,elements 600, 610, 620, 633, 640, and 650 are inseparably connected. Thetip 600 can have a region 603 for which the coil loops are more looselyspaced than in other regions, such as region 601 and 602.

The distal end of the electrode is the end of the active tip 600, andthe proximal end of the electrode is end of the cables 630. Electrodestructures that are more distal are closer to the distal tip 605.Electrode structures that are more proximal are closer to the generatorconnector 640 and/or to the injection port 650. The distal end of thestylet 660 is the distal tip 663. The proximal end of the stylet 660 isthe handle 661.

Referring now to FIG. 6B specifically, the electrode has wire 636, wire637, and safety strap 680. Wire 637 can be a constantan wire thatconnects to pin 643, and that connects to the distal end 605 of the coil601 at junction 682 to form a thermocouple junction. Wire 637 can be athermocoupe bifilar terminated by a thermocouple junction 682 thatconnects to two pins composing pin 643. Pin 643 is configured to providefor monitoring of the tip temperature by connection to atemperature-measurement device. Wire 637 connects to pin 642 and to coil601 to provide for conduction of electrical signals from aelectrosurgical generator attached to pin 642 to the active tip 600 ofthe electrode. In embodiments where a thermocouple junction is formedbetween a constantan wire 637 and the distal end 605 or the coil 601,the pin 642 can connect to a temperature-measuring device to provide formonitoring of the temperature of tissue in contact with the active tip600.

Wire 637 can enter the lumen coil 601 by passing between two loops ofcoil 601. In another embodiment, the wire 637 can enter the lumen of thecoil 601 be passing into the proximal end of the coil 601. In anotherembodiment, the wire 637 can enter the inner lumen of the coil 601 at amore distal point along the shaft than pictured in FIG. 6B; an advantageof this embodiment is that the stylet shaft 662 and the wire 637 cantouch each other over a shorter length. It is understood that astructure can be added to the end of the generator cable 633 where itconnects to the hub 620 that is configured to limit flow of fluids intothe generator cable 633, such as a glue plug.

FIG. 7 presents a unitized injection electrode with moveable stylet inan external view. In one embodiment, the embodiments presented in FIG. 7are equivalent to the embodiments presented in FIG. 6A and FIG. 6B, withthe difference that the generator cable branch labeled 633 in FIG. 6 isomitted in FIG. 7, and the injection port, labeled 650 in FIG. 6 andlabeled 750 in FIG. 7, is directly connected to the hub 720 in FIG. 7.The unitized injection electrode has tip 700 comprising a metallic coil701 with distal end 705, shaft 710 comprising electrical insulation 711covering the metallic coil 701, hub 720, connector 740 comprising body741 and pins 742 and 743, injection port 750, and movable stylet 760comprising hub 761 and shaft 762. In one embodiment, elements 700, 710,720, 740, and 750 are inseparably connected. The tip 700 can have aregion 703 for which the coil loops are more loosely spaced than inother regions, such as region 701 and 702.

FIG. 8 present an injection electrode system comprising a catheter 890and separate, movable stylet electrode 860, in accordance with oneaspect of the present invention. FIG. 8A presents one embodiment of theinjection electrode system in an external view. FIG. 8B presents oneembodiment of the internal construction of the injection electrodesystem, wherein the catheter 890 is shown in a cross-sectional view andthe electrode 860 is shown from its exterior, positioned within thecatheter 890. Referring to both FIG. 8A and FIG. 8B, the catheter 890comprises a tip comprising coil 801 and distal end 805, shaft 810comprising insulation 811 outside the coil 801, hub 820, and injectionport 850. The electrode 860 comprises shaft 862, hub 860, cable 830,generator connector 840 comprising body 841 and pins 842 and 843. Thedistal end of the catheter is the end of the distal point 805, and theproximal end of the electrode is end of the hub 820. Catheter structuresthat are more distal are closer to the distal tip 805. Catheterstructures that are more proximal are closer to the port 850. The distalend of the stylet electorde 860 is the distal tip 863. The proximal endof the stylet electrode 860 is the handle 861.

In one embodiment, when the electrode 860 is positions within the innerlumen of the catheter 890 and electrical signals are delivered to theelectrode shaft 862 by connecting the electrode to an electrical signalgenerator via connector 840, contact between the electrode shaft 862 andthe inner surfaces of the metallic coil 801, said electrical signals areconducted to the active tip 800 of the catheter 890 and therebydelivered to tissue in contact with the active tip 800. In oneembodiment, the injection electrode system in FIG. 8 can be used in theembodiments presented in FIG. 1A and FIG. 1B. The injection electrodesystem can provide for radiofrequency therapy by means of catheter 890placement in the spinal canal. The injection electrode system canprovide epidural anesthesia. The injection electrode system can providestimulation-guided RF and pulsed RF treatment of nervous structures,such as the DRG, via placement of the catheter 890 within the spinalcanal. The injection electrode system can provide for stimulation-guidedepidural anesthesia, such a lysis of adhesions. The injection electrodesystem can provide for temperature-monitoring of the catheter tip 800during medical use.

The port 850 can be integrated inseparably into the hub 820. In oneembodiment, the hub 820 and injection port 850 can be inseparablyconnected to the shaft 810. In another embodiment, a unitized hub 820and injection port 850 can be separable from the shaft; for example. Theunitized hub 820 and injection port 850 can take the form of atuohy-borst adaptor or another common type of injection adaptor that isfamiliar to one skilled in the art of epidural anesthesia. The electrodecan be moveable within the catheter. The electrode can be fully removedfrom the catheter. The electrode can be fully removed from the catheterto provide access to the injection port 850 for the injection of fluidthrough the catheter and outflowing from the catheter tip 800, forexample, for the purpose of effective epidural anesthesia.

In some embodiments, the shaft 810 and tip 800 of the catheter 890 canhave the same construction to the shaft and tip of electrodes presentedin FIGS. 2, 3, 4, 5, 6, and 7. In one embodiment, the coil 801 can be astainless steel spring coil of round wire. In one embodiment, the coil801 can be a stainless steel spring coil of flat wire. In oneembodiment, the coil 801 can be a laser cut stainless steel tube. It isunderstood that in other embodiments, the coil 801 is not present overthe entire length of the shaft 810; for example, the proximal end of thecoil 801 can be connected to metal tubing, such as stainless steelhypotube, to provide for a stiffer proximal part of the shaft. It isunderstood that multiple pieces of coil can be connected to form thecoil 801. In some embodiments, the catheter electrode system presentedin FIG. 8A and FIG. 8B has the same construction and function as theinjection electrode system presented in FIG. 9A and FIG. 9B.

The electrode 890 can have constructions that are familiar to oneskilled in the art of RF pain management. For example, electrode 890 canhave a construction similar to that of the Cosman CSK electrode. Forexample, electrode 890 can have a construction similar to that of theCosman TCD electrode. For example, electrode 890 can have a constructionsimilar to that of the Cosman TCN electrode, whose shaft includesnitinol. The electrode 890 can be a temperature-sensing electrode. Theelectrode 890 can have a thermocouple temperature sensor at its distal863. The electrode 860 can be configured to provide for the delivery ofradiofrequency current to the catheter 890. The connector 840 can beconfigured to connect to a radiofrequency generator.

Referring to FIG. 8A and FIG. 8B, the catheter 890 can be an epiduralcatheter. The catheter 890 can be an intravascular catheter. Thecatheter 890 can be configured for epidural anesthesia. The styletelectrode 860 can be configured act as a stylet for the catheter 890.The stylet electrode 860 can be configured to deliver electrical signalsto the active tip 800 of the catheter 890. The stylet electrode 860 canbe configured to deliver RF signals to the active tip 800 of thecatheter 890. The stylet electrode 860 can be configured to delivernerve stimulation signals to the active tip 800 of the catheter 890. Theinjection electrode system presented in FIG. 8 can be configured toeffect radiofrequency treatment, such as pulsed radiofrequencytreatment, on nerve structures by means of placement of the electrodesystem in the epidural space of a human body. One advantage of theinjection electrode system presented in FIG. 8 is that manufacture ofthe electrode 860 and the catheter 890 can proceed in parallel. Anotheradvantage of the injection electrode system presented in FIG. 8 is thatstandard epidural methods can be used in addition to RF methods in thesame medical procedure. Another advantage of the injection electrodesystem presented in FIG. 8 wherein the unitized hub 820 and injectionport 850 is separable from shaft 810 of the catheter 890, is that theneedle used to introduce the catheter 890 can be removed from thepatient while the catheter 890 is in place within the patient, bysliding said needle over the distal end of the shaft 810, as is familiarone skilled in the art of epidural anesthesia.

Referring now specifically to FIG. 8B, in one embodiment of theinjection electrode system, the catheter 890 has a safety strap 880connected to the proximal end of the coil 801 at junction 884 and to thedistal end of the coil 801 at junction 881. The junction 884 can be aweld, such as a laser weld. The junction 881 can be part of the weld,such as a laser weld or an electrical discharge weld, that forms theclosed end 805 of the catheter 890. The safety strap 880 can beconfigured to prevent the coil 801 from uncoiling during use. The safetystrap can be a metal wire. The safety strap can be a flat wire. Thesafety strap can be configured to have a low profile to allow entry ofthe stylet electrode's shaft 862 into the inner lumen of the coil 801.The safety strap can be configured to have a low profile to maintain anopen cross-sectional area within the inner lumen of the coil for theflow of injected and aspirated fluid. In embodiments where the safetystrap 880 is a metal wire, the safety strap can improve faithfulconduction of electrical signals delivered by the electrode 860 to theactive tip 800 of the catheter 890.

Referring to FIG. 8A and FIG. 8B, the length of the catheter 890 can bein the range 12-33 inches. The length of the catheter 890 can be lessthan 12 inches. The length of the catheter 890 can be greater than 33inches. The length of the catheter 890 can be 12 inches. The length ofthe catheter 890 can 33 inches. The length of the catheter 890 can be 16inches. The length of the catheter 890 can be 24 inches. The outerdiameter of the catheter 890 can in the range 18 to 21 gauge. The outerdiameter of the catheter 890 can be greater than 18 gauge. The outerdiameter of the catheter 890 can be less than 21 gauge. The outerdiameter of the catheter 890 can be 20 gauge. The outer diameter of thecatheter 890 can be 19 gauge. The diameter of the electrode 860 can beconfigured to produce a desired stiffness of the assembled cathetershaft 810. The stiffness catheter shaft 810 and tip 800 can beconfigured to facilitate safe placement of the catheter 890 in thespinal canal. The introducer needle for the catheter can be 15 gauge.The introducer needle for the catheter can be 16 gauge. The introducerneedle for the catheter can be 17 gauge. The introducer needle for thecatheter can be 18 gauge. The introducer needle can be an epiduralneedle, such as a tuohy needle.

For embodiments where the hub 820 and injection port 850 are attached tothe catheter shaft 810 (either separably as in the case where hub 820and port 850 are an injection adaptor port, or inseparably as in thecase where the hub 820 and port 850 are inseparable attached to thecatheter shaft 810), the length of the electrode 860 can be configuredso that when the electrode 860 is fully inserted into the catheter 890,the electrode's distal end 863 contacts the inner surface of the distalend 805 of the coil 801. One advantage of this configuration is that itprovides tactile physical feedback the user that the electrode 860 isfully inserted in the catheter 890. For embodiments where the hub 820and injection port 850 are attached to the catheter shaft 810 (eitherseparably as in the case where hub 820 and port 850 are an injectionadaptor port, or inseparably as in the case where the hub 820 and port850 are inseparable attached to the catheter shaft 810), the length ofthe electrode 860 can be configured so that when the electrode 860 isfully inserted into the catheter 890, the electrode's distal end 863cannot contact the inner surface of the distal end 805 of the coil 801.For example, as shown in FIG. 8B, the hub 861 of the electrode 860 canabut a surface of the port 850 to prevent further advancement of theelectrode shaft 862 to the catheter shaft 810. One advantage of thisconfiguration is that it ensures the distal end of the catheter 890remains floppy irrespective of the position of the electrode 860 in thecatheter 890. For embodiments where the hub 820 and injection port 850are not attached to the catheter shaft 810 and the electrode 860 isinserted directly in the proximal end of the catheter shaft 810, thelength of the electrode 860 can be configured so that when the electrode860 is fully inserted into the catheter 890, the electrode's distal end863 contacts the inner surface of the distal end 805 of the coil 801.One advantage of this configuration is that it provides tactile physicalfeedback the user that the electrode 860 is fully inserted in thecatheter 890. For embodiments where the hub 820 and injection port 850are not attached to the catheter shaft 810 and the electrode 860 isinserted directly in the proximal end of the catheter shaft 810, thelength of the electrode 860 can be configured so that when the electrode860 is fully inserted into the catheter 890, the electrode's distal end863 cannot contact the inner surface of the distal end 805 of the coil801. One advantage of this configuration is that it ensures the distalend of the catheter 890 remains floppy irrespective of the position ofthe electrode 860 in the catheter 890.

FIG. 9 presents a catheter electrode system comprising a catheter 990and separate, movable stylet electrode 960, in accordance with oneaspect of the present invention. FIG. 9A presents one embodiment of theinjection electrode system in an external view. FIG. 9B presents oneembodiment of the internal construction of the injection electrodesystem, wherein the catheter 990 is shown in a cross-sectional view andthe electrode 960 is shown from its exterior, positioned within thecatheter 990. Referring to both FIG. 9A and FIG. 9B, the catheter 990comprises a tip comprising coil 901 and distal end 905, shaft 910comprising insulation 911 outside the coil 901. The electrode 960comprises shaft 962, hub 960, cable 930, generator connector 940comprising body 941 and pins 942 and 943. In some embodiments, theelectrode 960 can be fully withdrawn from the catheter 990. The distalend of the catheter 990 is the end of the distal point 905, and theproximal end of the catheter 990 is end into which the electrode 960 canbe inserted. Catheter structures that are more distal are closer to thedistal tip 905. Catheter structures that are more proximal are closer tothe end into which the electrode 960 can be inserted. The distal end ofthe stylet electrode 960 is the distal tip 963. The proximal end of thestylet electrode 960 is the handle 961.

In some embodiments, the catheter electrode system presented in FIG. 9Aand FIG. 9B has the same construction and function as the injectionelectrode system presented in FIG. 8A and FIG. 8B. In some embodiments,the construction and function of the system presented in FIG. 9 is thesame as that presented in FIG. 8 with the difference that the hub 820and port 850 are not explicitly shown in FIG. 9. It is understood thatin some embodiments, an injection adaptor, for instance a tuohy-borstadaptor or removable injection hub 820 and 850, can be attached to theproximal end of the catheter 990 to provide for injection of fluids. Inone embodiment, the catheter 990 is an epidural catheter, familiar toone skilled in the art of epidural anesthesia. In one embodiment, thecatheter 990 is an epidural catheter constructed using a metal coil. Inone embodiment, the electrode 960 is a radiofrequency electrodeconfigured to move through the inner lumen of the catheter 990. In oneembodiment, the electrode 960 is configured to deliver electricalsignals, such as radiofrequency, pulsed radiofrequency, and stimulationsignals, to the active tip 900 of the catheter. In one embodiment,electrical signals delivered to the electrode 960 by connection of itsgenerator connector 940 to an electrical generator, are in turnconducted to the active tip 900 of catheter 990 by contact between theelectrode shaft 962 with the inner surface of the coil 901.

Referring now specifically to FIG. 9B, in one embodiment of theinjection electrode system, the catheter 990 has a safety strap 980connected to the proximal end of the coil 901 at junction 984 and to thedistal end of the coil 901 at junction 981. The junction 984 can be aweld, such as a laser weld. The junction 981 can be part of the weld,such as a laser weld or an electrical discharge weld, that forms theclosed end 805 of the catheter 990. The safety strap 980 can beconfigured to prevent the coil 901 from uncoiling during use. The safetystrap can be a metal wire. The safety strap can be a flat wire. Thesafety strap can be configured to have a low profile to allow entry ofthe stylet electrode's shaft 962 into the inner lumen of the coil 901.The safety strap can be configured to have a low profile to maintain anopen cross-sectional area within the inner lumen of the coil for theflow of injected and aspirated fluid. In embodiments where the safetystrap 980 is a metal wire, the safety strap can improve faithfulconduction of electrical signals delivered by the electrode 960 to theactive tip 900 of the catheter 990. In one embodiment, the electrode 960can be long enough that its distal end 963 contacts the inner distalsurface 905 of the catheter 990 when it is fully inserted into thecatheter 990. In one embodiment, the electrode 960 is configured suchthat its distal end 963 does not contact the inner surface of the distalend 905 of the catheter 990, when the electrode 960 is fully insertedinto the catheter 990. For example, as shown in FIG. 9B, the hub 961 ofthe electrode 960 can be constructed to abut the proximal end of thecatheter 890 and thereby prevent the distal end 963 of the electrodeshaft 962 from contacting the distal end of the inner lumen of the coil901.

1. A unitized system, comprising: a flexible electrode having a shaftand the shaft of the electrode has a proximal end and distal end, theproximal end being electrically insulated, and the distal end beingelectrically uninsulated; an injection port inseparably coupled to theflexible electrode; a temperature sensor at the distal end of theelectrode that measures the temperature at the tip of the electrode; andan electrical connector inseparably coupled to the flexible electrode;wherein the unitized system is a one-piece device joined by gluing,welding, soldering, crimping, hooking, or mechanical locking that isconfigured to deliver injected fluids and electrical signal to a targettissue at the same time.
 2. The device of claim 1, wherein the electrodeis configured for placement in the spinal canal.
 3. The device of claim1, wherein the electrode is configured for placement in the epiduralspace. 4.-6. (canceled)
 7. The device of claim 6, wherein the electricalconnector is coupled to an electrical supply that provides an electricalsignal and a temperature signal from the temperature sensor is used tocontrol the electrical signal from the electrical supply.
 8. The devicein claim 7, wherein the electrical signal is a radiofrequency signal. 9.The device in claim 8, wherein the electrical signal is a pulsedradiofrequency signal.
 10. The device in claim 7, wherein the electricalsignal is a nerve stimulation signal.
 11. The device in claim 5, whereinthe electrode shaft comprises a metallic coil that has a proximal endcovered by an electrically-insulative material.
 12. The device in claim11, wherein the metallic coil is a stainless steel spring coil.
 13. Thedevice in claim 11, wherein the electrically-insulative material is aplastic tube.
 14. The device in claim 13, wherein the plastic tube is aheat-shrinkable tube.
 15. The device claim 11, wherein the distal end ofthe coil is closed by a weld.
 16. The device claim 15, wherein the weldis a temperature sensor.
 17. The device of claim 16, wherein theelectrical connector is coupled to an electrical supply that provides anelectrical signal and a temperature signal from the temperature sensoris used to control an electrical signal from the electrical supply. 18.The device in claim 1, wherein fluids injected into the injection portoutflows through the distal end of the electrode.
 19. The device inclaim 11, wherein a wire within the lumen of the coil is connected tothe coil at both the distal and proximal ends of the coil.
 20. Aunitized injection electrode with a proximal and a distal end comprisingthe following inseparably connected elements: a metallic coil;electrical insulation that covers the proximal end of the coil andleaves the distal end of the coil uninsulated; an injection portconnected to the proximal end of the coil and configured such that fluidinjected into the port flows out of the uninsulated distal end of thecoil; a temperature sensor at the distal end of the electrode thatmeasures the temperature at the tip of the electrode; an electricalconnector configured so that an electrical signal delivered to theelectrical connector is delivered to tissue in contact with theuninsulated distal end of the coil; wherein the unitized injectionelectrode is a one-piece device joined by gluing, welding, soldering,crimping, hooking, or mechanical locking that is configured to deliverinjected fluids and electrical signal to a target tissue at the sametime.
 21. The device in claim 20, wherein the electrical signal is aradiofrequency signal.
 22. The device in claim 20, wherein the electrodeis configured for placement in the epidural space.
 23. The device inclaim 20, wherein the distal end of the coil is closed by a weld. 24.(canceled)
 25. The device in claim 20, wherein a metal rod within thelumen of the coil is connected at both the distal end of the coil and tothe proximal end of the coil.
 26. The device in claim 23, wherein theweld captures thermocouple wires to form a thermocouple temperaturesensor, the weld captures the distal end of a metal rod that is alsoconnected to the proximal end of the coil, and temperature signals fromthe temperature sensor can be measured by connection to a temperatureconnector that is inseparably attached to the electrode.
 27. The devicein claim 20, wherein the coil is a stainless steel coil.
 28. The devicein claim 20, wherein the coil is a stainless steel coil made from roundwire.
 29. The device in claim 20, wherein the electrical connector alsoincludes connectors to the temperature sensor.
 30. A flexible catheterwith a metallic tip and an electrode configured to be placed within thelumen of the catheter.
 31. The device in claim 28 wherein the catheterhas an electrically insulated proximal end and an uninsulated distalend, so that electrical signals delivered to the electrode are deliveredto tissue in contact with the uninsulated distal end of the catheter.32. The device in claim 29 where the catheter is an epidural catheter.33. The device in claim 28 where the electrode is a radiofrequencyelectrode.
 34. The device in claim 29 where the electrode has atemperature sensor that can be positioned in the uninsulated active tipof the catheter when the electrode is inserted into the electrode.
 35. Acatheter delivery device to transmit radiofrequency energy to a spinalcanal, comprising: a needle having an open proximal end and an opendistal end, and a lumen that extends from the open proximal end to theopen distal end; a catheter having a blunt, metallic tip on a distal endof the catheter that transmits a radio frequency energy to the treatmentsite, wherein the catheter is telescopically disposed within the needlelumen to allow the tip to be maneuverably positioned within the spinalcanal; a catheter hub coupled to a proximal end of the catheter; ametallic wire element telescopically disposed within a lumen of thecatheter; and an adapter hub coupled to a proximal end of the wireelement; wherein the adapter hub is cooperatively engageable to thecatheter hub to form a single shaft, wherein a proximal end of theadapter hub is configured couple to a radio frequency generating device,wherein the adapter hub and the catheter hub are sized and dimensionedrelative to one another such that engagement of the adapter hub to thecatheter hub prevents the distal end of the wire element from touching aseating surface of the tip, and wherein the wire element contactsmetallic elements inside the length of the catheter lumen so that thewire element delivers a radio frequency energy from the radio frequencygenerating device to the tip.
 36. The device of claim 33, wherein alength of the catheter is longer than a length of the needle.
 37. Thedevice of claim 33, wherein the catheter is flexible.
 38. The device ofclaim 33, further comprising a layer of insulating material coupled to aportion of the catheter, wherein the insulating material prevents aradio frequency energy from transmitting.
 39. The device of claim 36,wherein the insulating material encapsulates all but the distal end ofthe catheter.
 40. The device of claim 35, wherein the insulatingmaterial terminates 10 mm from the distal end of the catheter.
 41. Thedevice of claim 33, wherein a portion of the catheter is not straight toimprove steerage of the catheter.
 42. The device of claim 33, whereinthe distal end of the needle is sharpened to penetrate an outer layer ofthe treatment site.
 43. The device of claim 33, wherein the distal endof the wire element and the seating surface of the tip are formed tohave complementary configurations to facilitate the engagement betweenthe distal end of the wire element and the seating surface of the tip.44. The device of claim 36, wherein the catheter's distal end isconstructed from a metallic coil, the proximal end of which is coveredby an electrically-insulative material.